Q2 2020 | Los Angeles Medicine Magazine

OFFICIAL PUBLICATION OF THE LOS ANGELES COUNTY MEDICAL ASSOCIATION

INTERAC TI V E

THE NEW THREAT TO MICRA: A WOLF IN SHEEP’S CLOTHING A massive response from organized medicine and its allies can save a pillar of California healthcare from a veiled attack.

QUARTER 2 2020

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PUBLISHER Gustavo Friederichsen | gustavo@lacmanet.org EDITOR Sheri Carr | editor@physiciansnewsnetwork.com ADVERTISING SALES Dari Pebdani 858.231.1231 | dpebdani@gmail.com

VOLUME 151 ISSUE 2 | QUARTER 2 2020

EDITORIAL ADVISORY BOARD David H. Aizuss, MD Troy Elander, MD Thomas Horowitz, DO Robert J. Rogers, MD HEADQUARTERS LOS ANGELES COUNTY MEDICAL ASSOCIATION 1055 West 7th Street, Suite 2290 | Los Angeles, CA 90017 Tel 213.683.9900 | Fax 213.226.0350 www.losangelesmedicine.org LACMA OFFICERS PRESIDENT | Sion Roy, MD PRESIDENT-ELECT | Diana Shiba, MD TREASURER | Jeffery Lee, MD SECRETARY | Omer Deen, MD IMMEDIATE PAST-PRESIDENT | C. Freeman, MD, MBA, FAPA LACMA BOARD OF DIRECTORS COUNCILORS-AT-LARGE TRUSTEES & CHAIR DELEGATION Jerry Abraham, MD (1) Jack Chou, MD, CMA Trustee Samuel Fink, MD (6) Po-Yin Samuel Huang, MD, Chair of the LACMA Delegation Sunny Jha, MD (1) Sion Roy, MD, CMA Trustee Karen Sibert, MD (5) Valencia Walker, MD (5) COUNCILORS Robert Bitonte, MD, JD (D1) Emil Avanes, MD (D2) Stephanie Booth, MD (D3) Troy Elander, MD (D5) Marc Mendes, MD (D6) David Hopp, MD (D7) Steven Sawelson, MD (D9) Christine Phan, MD (D10) William Hale, MD (D14) Nancy Ellerbroek, MD (D17) Lisa Firestone, MD (SCPMG) Roxana Yoonessi, MD, JD (SCPMG) Heather Silverman, MD (SSGPF) Muntu Davis, MD (LA County) Po-Yin Samuel Huang, MD (1, YP Councilor) Hector Flores, MD (1, EPC Chair) Anna Yap, MD (Resident Councilor) Cecilia Leggett, MD (Alt. Resident Councilor) Ali Tafreshi (Student Councilor, USC) Stacy Songco (Alt. Medical Student Councilor, UCLA)

2 3 4 5

PRESIDENT’S LETTER | Sion Roy, MD

Bill Introduced to Protect Physicians from Unfair Lawsuits During COVID Pandemic

A MESSAGE FROM LACMA CEO

Gustavo Friederichsen

LACMA Launches LA4Docs.org in Support of LA County Physicians

Join LACMA CEO for a Tour of LADocs.org Resources for COVID and Beyond LACMA’S COVID-19 RAPID RESPONSE INITIATIVE

6 8

LACMA’s Board of Directors consists of a group of 31 dedicated physicians working hard to uphold your rights and the rights of your patients. They always welcome hearing your comments and concerns. You can contact them by emailing or calling Lisa Le, VP of Operations and Strategic Initiatives, at lisa@lacmanet.org or 213-226-0304.

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PPE Distribution Events Provide Equipment to Hundreds of LA County Docs Guidelines and Best Practices for Reopening Your Medical Practice

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LACMA PRESIDENT

S I O N R O Y, M D

It Has Been My Honor to Serve as Your President The spring of 2020 has been incredibly challenging for everyone in LA County, California, our nation, and the rest of the world. The COVID-19 pandemic has had a vast impact on our society in so many ways including in terms of public health, the economy, social norms and restrictions, and education. The virus itself has had an immense impact in LA County with immense morbidity and mortality. More than half of COVID-related deaths in California have occurred in our county, and the virus is particularly lethal on the elderly.

As our healthcare system and society have dramatically changed over the course of a very short period of time, LA County physicians have confronted so many novel barriers to caring for their patients, including lack of personal protective equipment (PPE), lack of proper telehealth infrastructure for remote visits, and an inability to perform the routine care on patients that is the bread and butter of what we do.

At LACMA, we have recognized the challenges that physicians have faced, and we have taken robust action on behalf of our physicians and patients. We have invested $125,000 in helping physician practices obtain PPE so that physicians and their staff can safely treat their patients. In addition to financial assistance, we have obtained and distributed thousands of KN95 masks and shields ourselves to hundreds of physician practices with drive-through PPE distribution events in Torrance and Santa Monica. We have also assisted physicians in obtaining access to telehealth systems at an affordable price.

LACMA has also done extensive legislative advocacy over the past few months on behalf of our

Thank you to the LACMA staff for everything you do on behalf of physicians and patients in LA County.

Working with you has truly been an inspiration.

2 LOS A N G EL ES M ED I CI N E | Q UA RT ER 2 2020

physicians and patients. We have virtually met with almost all of the LA County legislative delegation, both individually and as a group, and have worked closely with the LA County Department of Public Health. We have advocated for robust economic relief for physician practices so that they can remain open and maintain access to care for their patients.

Additionally, we have fought for more efficient PPE distribution practices and improved access to childcare during the pandemic for healthcare workers. Finally, we have tried to convey accurate information to both physicians and the general public. We’ve created two new websites, hosted multiple town halls, and have had a large presence in the media.

Finally, this past week, our nation has witnessed further turmoil with the horrific murder of George Floyd that has resulted in nationwide protests.

At LACMA, we are committed to addressing the systemic racism present not only in our justice system, but in our healthcare system as well. The COVID-19 crisis has clearly revealed the racial inequities in access to care that exist in Los Angeles County and our society at large. CDC data shows that the death rates from COVID-19 are substantially higher among black and Hispanic Americans than other races. In the coming weeks, we will announce a collaborative effort with our Patient Care Foundation to help minority- and women-owned practices, as well as practices that predominantly serve minority populations, which have faced daunting challenges during the pandemic with inadequate support.

LACMA will be proud to step up to this task to help preserve access to care for the most vulnerable, mostly minority, Angelenos.

It has been my honor to serve as your president through these difficult times. Thank you to the LACMA staff for everything you do on behalf of physicians and patients in LA County. Working with you has truly been an inspiration. Congratulations to my friend, Dr. Diana Shiba, as she begins her presidency in July!

Congress will be considering a bill – the Coronavirus Provider Protection Act (HR 7059) – that would provide healthcare professionals, and the facilities in which they work, protections from COVID-19-related lawsuits. The legislation was introduced by Reps. Phil Roe, MD (R-Tenn.) and Lou Correa (D-Calif.).

Developed in collaboration with the American Medical Association (AMA), the national specialty societies, a few state medical associations, and the Health Coalition on Liability and Access (HCLA), the narrowly crafted liability protections would apply only when: •

Bill Introduced to Protect Physicians from Unfair Lawsuits During COVID-19 Pandemic

• • • •

•

The act or omission occurred during the declared COVID-19 public health emergency or within 60 days of termination of the emergency; The act or omission occurred while providing or arranging care; The act or omission was taken based on direction or guidance from any federal, state, or local official/department/agency; The act or omission was taken due to a lack of resources attributable to the declared emergency; The services were within the provider’s scope of licensure/ certification, without regard as to whether the service fell within the usual scope of practice; and The services were provided in good faith.

The California Medical Association (CMA) and the California Hospital Association (CHA) have also urged Congress to pass legislation that includes protection against unfair lawsuits for healthcare workers.

Physicians and hospitals are on the front lines of a crisis unlike any our nation has ever faced. Every hospital and physician in California was called upon to prepare for a surge of acutely ill patients. Providers stepped up, responding to the call to action by ceasing non-essential services and creating new patient care units in tents, arenas, convention centers and other unlikely spaces.

The pandemic has created a public health emergency that is rapidly altering the provision of healthcare services across the country based on guidance and recommendations from the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, and other federal, state, and local government directives.

Physicians were under public health orders to refrain from providing nonurgent care, such as cancer screenings and annual exams. That inevitably will mean that some diagnoses were missed or delayed. Physicians were asked to delay non-urgent surgeries to make beds available for COVID-19 patients.

That meant delaying care to patients who need biopsies, heart valve replacements, or gallbladder removals. Saving the lives of patients afflicted with a new pathogen means trying drugs, doses or procedures without full knowledge of all the ramifications.

Healthcare providers need assurance they will not later be judged or sued when abiding by the government’s directives to create surge capacity, or when making care decisions based on their best judgment and determination at the time.

As providers continue their work in the coming weeks and months, we must give them the support they need to make the best possible decisions, including protections from future legal action, as long as that protection does not excuse willful malicious intent to cause harm.

LACMA CEO

G U S TAV O F R I E D E R I C H S E N

Creating Change A pandemic. Medical practices closed. Physicians in crisis. No PPEs. Staffs laid off. Lives changed for possibly years. When I was writing this column, we had lost nearly 110,000 Americans to COVID-19 with almost 2 million sick. In Los Angeles 57,000 tested positive, with nearly 2,500 losing their lives. Yes, we’ve helped more than 400 practices with funding, supplies and resources. But it’s not enough. The good news, thanks to our forward-thinking executive committee, is that we were able to pivot to helping minority practices and those serving communities of color through a partnership with the Patient Care Foundation. Thank you, Dr. Elander! This profound work continues as we strive to help these practices with additional funding to reopen, rehire and care for the most vulnerable communities in the county.

And, just as practices and businesses began to reopen and generate revenue, the death of George Floyd in Minneapolis shook us all to our core.

Following the shootings in Dallas, Texas, in 2016, LACMA held the historic “The Searing Journey” event with black physicians where 50 doctors shared their own experiences with racism. Four years later, LACMA, like so many organizations, has moved on. This will change. Yes, our focus was to reinvent the organization in order to grow. That has happened as we have more than 7,000 members. But black physician membership remains very low. Our responsibility as an accountable, thoughtful organization will be to create a new LACMA, one that includes a core belief that racism will not be tolerated. LACMA will be part of the dialogue and, in some cases, lead the conversation to create change, to be impactful, to support our physicians of color, their patients and their communities.

I also want to take a moment and thank LACMA President Dr. Sion Roy for his leadership.

Shy was instrumental in helping LACMA evolve to something better. He made us all better.

We were able to reach historic milestones because Shy, first and foremost, partnered with staff to create value for both members and communities. Docs4LA, COVID-19 Rapid Response, an immediate response and plan in the wake of the George Floyd killing, a vibrant and engaged executive committee and board of directors, a revitalized LACPAC, stronger ties with CMA and coordination with our Patient Care Foundation and partnership with our districts were all achievements thanks to Dr. Roy’s uncanny ability to work with staff to support LACMA’s mission, vision and values.

“...LACMA will be part of the dialogue and, in some cases, lead the conversation to create change...”

SCAN WITH PHONE CAMERA to Visit LADocs.org COVID-19 Homepage 4 LOS A N G EL ES M ED I CI N E | Q UA RT ER 2 2020

JOIN LACMA CEO FOR A VIDEO TOUR OF

LADocs.org Physician Resources for COVID-19 and Beyond LACMA Launches LA4Docs.org in Support of LA County Physicians LACMA is proud to announce the launch of LA4Docs.org, a website created exclusively in support of physicians in Los Angeles County.

“LACMA continues to find ways to support physicians on the front lines of the COVID-19 crisis, those caring for patients, those with practices that have closed or laid off staff. LA4Docs.org offers free and discounted products and services for physicians,” said LACMA CEO Gustavo Friederichsen. “The site will also feature a place for community colleagues thanking colleagues, and the community can share their sentiments, thanking physicians for what they do each and every day. I encourage physicians to visit the site and post a message or video.”

LA4Docs.org includes pages dedicated to: • • • • • • • •

Healthcare Workers Discounts Giving Blood Helping Hospitals Keeping Los Angeles Safe Linking Suppliers with Organizations in Need Masks Mental Health Services Thanking Doctors

“Since 1871, LACMA has supported physicians.

Never before in the nearly 150 years of existence has the organization witnessed physician stress, anguish, pain turn to resilience, strength, perseverance and dignity as physicians continue to put their own lives on the line from New York to Los Angeles, Rome to Wuhan,” the website explains. “It is for this reason, physicians and healthcare workers giving so much and not asking for anything in return, that LACMA has created the LA4Docs effort.”

SCAN WITH PHONE CAMERA to take the video tour

“As we continue with the LACMA COVID-19 Rapid Response Initiative, I want to share that LACMA has an abundance of resources for physicians in the community. We’ve ordered close to 10,000 masks, shields, hand sanitizers and office supplies for physicians. We had a successful PPE curbside pickup event where we helped 130 practices with supplies. We are closing in on nearly 400 practices helped during the pandemic. In addition to the resources shared in this video, we now have a way for physicians to order their own masks and shields by visiting www.la4docs.org,” Gustavo shared. “LACMA is committed to continuing our support of physicians as we enter each new phase of the COVID-19 pandemic and beyond.”

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LACMA COVID-19 RAPID RESPONSE INITIATIVE

PPE Distribution Events Provide Equipment to Hundreds of LA County Docs

Above: Physicians line up to receive PPE at Habitat LA ReStore.

Bottom: LACMA staff prepare hundreds of bags with PPE equipment, supplies and information for distribution at the events.

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Since the launch of the LACMA COVID-19 Rapid Response Initiative in mid-March, LACMA has raised nearly $125,000 in funds and provided approximately 400 medical practices with financial assistance, telehealth subsidies, resources. PPE supplies, and more.

In recent weeks, LACMA has provided hundreds of PPEs to Los Angeles County physicians and community-based organizations through two community events.

On April 21, in partnership with Habitat LA ReStore, LACMA held its first PPE distribution event, with curbside pickup and county-wide courier delivery. Staff from Habitat for Humanity and LACMA safely handed out nearly 9,000 KN95s, 200 NIH standard shields, 1,000 hand sanitizers, telehealth subsidy program information, and office supplies to nearly 250 physician practices. “Thank you to Habitat for Humanity Los Angeles.

We are honored to support our frontline and community organizations.�

In May, a partnership between LACMA and Santa

Monica College provided another 150 LA County physicians with curbside pickup of KN95 masks, face shields, hand sanitizers and other critical office supplies.

“Healthcare workers are short on PPE everywhere, whether they’re community physicians or work at large hospital groups, so we really have been focused on investing more than $100,000 of our own funding to help physicians sort this mess out and get the PPE they need,” Dr. Sion Roy, president of the Los Angeles County Medical Association, told the Santa Monica Daily Press. “It’s not just a funding issue. It’s also a pipeline issue — as I’m sure you know — because we can’t just go on Amazon and order what we need. So LACMA has spent an immeasurable amount of man-hours trying to track down a supplier and provide resources to those who need it.”

“We followed 30 to 40 leads; a lot of them were international, domestic and local, but almost all of them fell through for various reasons,” Roy continued, detailing how fraud and trade restrictions have made the marketplace for supplies unnavigable in recent months. “But we finally have found a local distributor,” which is something he and LACMA are thankful for, because droves of residents have shown up to both of the recent curbside events.

“We’re just trying to do everything we can to help physicians stay open,” Roy said.

If you are a Los Angeles County physician in need of assistance, please visit ladocs.org/coronavirus to apply for assistance or find links to information that will be useful.

Top: The LACMA and Habitat for Humanity staff ready to distribute PPEs to LA County physicians.

Middle: LACMA President Sion Roy, MD, gives a socially distanced interview to local media.

Below: Physicians line up to receive PPE at Santa Monica College.

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Guidelines and Best Practices for Reopening Your Medical Practice As the COVID-19 pandemic spread, Los Angeles County, along with the rest of the state, took steps to limit the transmission and impact of the virus by implementing stay-at-home orders. While this has helped to prevent any surges overwhelming our hospitals, it has also meant that many other parts of the healthcare system were idled.

Now, as we begin to creep back into a normal rhythm and public health experts determine that it is safe to see patients and stay-at-home restrictions are relaxed, the Centers for Medicare & Medicaid Services (CMS), American Medical Association (AMA) and California Medical Association (CMA) have published guidelines for physician practices to strategically plan when and how best to begin to reopen.

CMS published a Phase 1 Guide to reopening facilities providing non-emergent, non-COVID care, while the AMA released a guide to give medical practices at the federal, state and local levels a checklist to ensure medical practices are ready for opening. The AMA guide was last updated May 1.

As you begin to strategically plan when and how best to reopen, the American Medical Association believes that four signposts must exist before state and local governments relax stay-at-home orders: • Minimal risk of community transmission based on sustained evidence of a downward trend in new cases and fatalities • A robust, coordinated and well-supplied testing network • A public health system for surveillance and contact tracing • Fully resourced hospitals and healthcare workforce The California Medical Association (CMA) has developed a set of best practices for physicians to consider as they move to safely and cautiously reopen their medical practices for office visits. The document includes steps to take prior to reopening, financial and staffing considerations, and universal safety precautions.

Steps to Take Prior to Reopening 1. Consult the Local Public Health Department | LA County has provided guidance for resuming deferred and preventive healthcare in Los Angeles County.

2. Construct Financial, Staffing Plans for Reopening | Practices that have shut down completely will need to plan for a gradual reopening. It is likely that patient volume will return slowly, and the office may not need to be fully staffed at all times. Practices should plan both their finances and staffing to account for this reality.

3. Develop Safety Protocols | Patients may be fearful about interacting with the healthcare system. With proper safety precautions in place, a physician’s office is one of the safest places a patient can be. See Universal Safety Precautions for Practices and Facilities for a list of best practices, developed by the CMA Task Force for Reopening the Health Care System.

4. Assess the Supply of Personal Protective Equipment | Both the federal Centers for Disease Control and Prevention (CDC) and the California Department of Public Health have published guidelines for the use of personal protective equipment (PPE).

5. Consider the Role Telehealth Will Play in Reopening | During the pandemic, many physicians have either implemented or expanded the use of telehealth to continue seeing patients.

Practices that have not yet implemented telehealth may wish to consider how it can support safe patient care during reopening.

Practices that have implemented telehealth can work on moving to a hybrid model, with patients seen both in office and virtually. | As practices 6. Clearly Communicate with Patients reopen, they should communicate with their patients clearly about their safety protocols. Many of the changes a practice might make will require patients changing their usual routines. Informing them upfront will serve to allay their concerns and ensure that they are properly prepared.

7. Be Watchful of Medication Shortages | Patients coming back to their doctors, combined with potentially compromised supply chains, may make it difficult for patients to get their usual medication. Physicians should consider alternatives and set expectations with patients if medications become unavailable.

Financial Considerations 1. Consider Capital Needs, Available Funding Sources | As practices reopen, revenue and patient volume may increase slowly and unevenly. Physicians should carefully consider their capital needs for reopening, and all available funding sources, both private (bank loans) and public (such as SBA loans or government grant funds). For more information about financial resources please see CMA’s COVID-19 Financial Practice Toolkit for Medical Practices. .

2. Address Accounts Payable | Organize your accounts payable and develop a plan to repay any vendors in which you deferred payment including rent, utilities, vendors, CMS advanced payments or any other payor advanced payment or loans.

Maintain open lines of communication with payors and vendors on payments due that you may need to defer.

3. Plan to Meet Existing Obligations | Practices should review contractual obligations from managed care payors, such as timely filing limits for claims and appeals, or submission of any encounter and/or quality data required. It is also a good idea to check employment agreements, vendor contracts and lease agreements. Reviewing these agreements and contracts for any clauses regarding termination, late payments, late fees, interest, etc. can save bigger headaches down the road. Maintain open lines of communication with payors and vendors on reporting or other obligations that you may not meet.

4. Develop a Monthly Budget | This will help on a go-forward basis as things move to normal business. Practices can identify what costs the most on a monthly basis and adjust as necessary.

The Centers for Medicare & Medicaid Services (CMS) has published a Phase 1 guide for reopening facilities to provide non-emergent, nonCOVID care.

Building upon that guidance, the AMA suggests using the following checklist to ensure that your medical practice is ready for reopening:

Comply with governmental guidance Make a plan Open incrementally Institute safety measures for patients Ensure workplace safety for clinicians and staff Implement a tele-triage program Screen patients before inperson visits Coordinate testing with local hospitals and clinics Limit non-patient visitors Contact your medical malpractice insurance carrier Establish confidentiality / privacy Consider legal implications

5. Talk to Vendors | If vendors know that the office is reopening, and will have revenue again, they may be willing to negotiate reduced rates, deferred payments or other considerations. Practices should contact vendors and see what they are offering to help with startup of the medical practice.

6. Tackle Accounts Receivables Slowly | As the office reopens, practices should continue or re-start collection activity and implement an internal process to follow up on outstanding claims. Office staff can pull financial reports (Insurance Aging, Patient Aging, Adjustment Report, ideally starting in the 60-day and older aging buckets). The goal should be to make sure every claim has been followed up on patient schedules for the upcoming one or two weeks.

For more information on employment issues, please see the CMA COVID-19 Toolkit for Physician Employers.

7. Verify Patient Contact and Insurance Information | When patients return to the office, their life circumstances may have changed. Office staff should confirm patient contact information, including address and phone number. Patient insurance eligibility and benefits should be checked to determine if eligibility is effective, or if copay and deductible amounts have changed. If patients have an outstanding balance, practices can offer payment plans. It is important to communicate with patients at the time of confirming appointments.

8. Analyze Revenue Streams | Billing staff should understand the Days Revenue Outstanding (DRO), which is the average number of days it takes to collect on the practice’s accounts receivable. It is important to have an accurate understanding of revenue streams as payments may have been delayed, compared to past revenue trends, or incorrect due to payor delays in implementing telehealth requirements or other related factors.

STAFFING CONSIDERATIONS 1. Right-Size Physician and Staff Work Force | As noted above, practice revenue and patient volume may come back slowly, in cycles and unevenly. To prepare for this, practices should consider staffing adjustments, which may include bringing staff and physicians back in different waves. Personnel can be placed on rotating teams or via telecommuting for certain positions if possible.

2. Consider Options for Vulnerable Staff | Working in healthcare immediately puts healthcare workers at risk and at higher exposure. The risk is even higher for vulnerable staff – those over the age of 60 or with preexisting conditions. Having internal policies for these workers can help all employees feel safe while working.

Workers in vulnerable populations may be shifted to different roles that minimize their risk of exposure. This may include various duties, such as consulting with younger staff, advising on the use of resources, keeping staff updated on most recent news, ordering of supplies for the clinic, working from home, phone triage of patients, helping providers and managers make tough decisions, or talking to patients’ family members.

For resources to address the mental and emotional needs of staff, contact the CMA Wellness “Care 4 Caregivers Now” Program.

3. Give Extra Care and Attention to the Emotional and Physical Needs of Staff | The pandemic has required physicians and many other healthcare workers to work long hours in dangerous conditions. As the healthcare system reopens, practices should pay extra attention for signs of exhaustion, depression, stress and other similar issues.

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Universal Safety Precautions for Practices and Facilities As physician practices and healthcare facilities reopen, every precaution should be taken to minimize the risk of infection, for both office staff and patients. CMA recommends that all practices and facilities adopt comprehensive safety protocols. Below is a list of best practices. Some of the recommendations below may not apply to certain practices, so physicians and office staff should adjust them for individual circumstances.

1. Maintain Physical Distancing | Physician office space and workflow should be structured to encourage physical distancing. Here are a few ideas for practices to consider: • Ask patients to check in by phone or text message and wait in the car until an exam room is ready.

• Prohibit adults and teens from having guests or visitors. Only parents of younger children should be in the office with the patient.

• Schedule patients such that only a few are in the office at any one time. Practices can consider offering evening and weekend hours and leaving more time in between patients.

• Put away articles such as magazines, toys, coffee, or anything else that may be handled by infected patients.

• If possible, arrange office flow such that patients enter and leave through separate doors.

• As able, modify check-out procedures to minimize/avoid any patient time in central area or at check-out desk.

• Consider setting aside clinic hours for vulnerable patients – elderly, immunocompromised, etc.

• Separate patients with respiratory symptoms so they are not waiting among other patients seeking care.

• Consider strategies to prevent patients who can be seen at home via telehealth from coming to your facility, potentially exposing themselves or others to germs.

2. Require Universal Face Covering 3. Implement Strict Sterilization Procedures 4. Continue to Use Telehealth, as Appropriate | LACMA recently announced a telehealth partnership with Santa Monica-based PatientPop, exclusively endorsing their PatientPop telehealth solution to ensure their physician members have the technology, resources, and tools they need to serve their patients during the COVID-19 crisis. Learn more here.

5. Pre-Screen Patients for Possible COVID-19 Symptoms | At the time of scheduling, patients should be asked if they are experiencing common COVID-19 symptoms – dry cough, fever, etc. All patients, regardless of symptoms, should have their temperature checked as they enter the office. Patients displaying COVID-19 symptoms should be screened telephonically, and tested if possible, before coming to the office. Physicians should keep up-to-date on the recommendations for preventing spread of COVID-19 on CDC’s website.

6. Preserve Personal Protective Equipment | All staff should be trained on the proper use of personal protective equipment. Practices should follow CDC guidelines for extended use and reuse of PPE. 7. Establish a Quarantine Policy

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Delivering the best imaginable service and unrivaled rewards is at the core of who we are. As an organization founded and led by physicians, we understand the value of superior care. Because for us, it’s not just a best practice, it’s in our unique code. Join us at thedoctors.com

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“At First Republic, we get one-on-one care and attention.

The Bank treats us like we treat our patients.”

C A L I F O R N I A PAC I F I C O RT H O PA E D I C S

Pictured left to right; back row: John P. Belzer, M.D.; Jon A. Dickinson, M.D.; Mark A. Schrumpf, M.D. mid row: Robert E. Mayle, M.D.; Lindsey C. Valone, M.D. front row: W. Scott Green, M.D.; Keith C. Donatto, M.D.; center: Peter W. Callander, M.D., Chairman

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