Q-Sights Key Insights – Volume 32

01/10/20220 – 01/08/2020

Here are the key topics you need to know about COVID-19 this week. To help you stay abreast of the latest COVID-19 news, guidelines and best practices from Federal, State, National Health Agencies and QHR Health, visit the QHR Health COVID-19 Online Resource Center.

Supply Chain and Pharmacy

  • Please continue to monitor the HealthTrust COVID-19 Resource Center for the latest information on supply chain and pharmacy, treatments, vaccines, instructions, training webinars, and much more.
  • HealthTrust recently completed a monograph for Baricitinib/Olumiant. There have been many questions regarding this drug, and you can find the document here: HealthTrust Drug Information Documents.

Clinical Care

CDC Recommendations for Phased Vaccination Approach

  • CDC recommends giving COVID-19 vaccine in phases:
    • Healthcare personnel and long-term care facility residents.
    • Frontline essential workers and people age 75 years and older.
    • People age 65 through 74 years, people age 16 through 64 years with underlying medical conditions, and other essential workers.
  • CDC’s recommendations are based on recommendations from the Advisory Committee on Immunization Practices (ACIP), an independent panel of medical and public health experts. The recommendations were made with these goals in mind:
    • Decrease death and serious disease as much as possible.
    • Preserve functioning of society.
    • Reduce the extra burden COVID-19 is having on people already facing disparities.

Management of Anaphylaxis After COVID-19 Vaccination

  • The CDC has provided interim considerations for the initial assessment and management of anaphylaxis following a COVID-19 vaccination. Institutional practices and site-specific factors may also be considered. In all cases, appropriate medical treatment for severe allergic reactions must be immediately available in the event that an acute anaphylactic reaction occurs following administration of a COVID-19 vaccine.

Perioperative Services

  • If you are a member of perioperative services and are looking for answers to COVID-19 situations that have never presented before, the AORN has an Updated Clinical Information FAQs page. This is a great resource for questions about any of the following areas: PPE, surgical precautions, transmission based precautions, environmental cleaning, ASC, leadership, ventilators, and sterilization.
  • Some recent Q&A updates to this site include:
    • Should COVID-19 precautions be taken for all surgical patients?
      • Depending on your local situation and patient population, it may be ideal to have everyone in the OR wear respiratory protection for all patients regardless of COVID-19 status, but this decision should take into account not only your N95 supply in the present time but also your projected usage, as this shortage is expected to continue for months. While there have been concerns about lab testing and asymptomatic patients, many places simply do not have the resources to use N95 respirators as a universal approach for all surgical patients. The CDC currently only recommends N95 use for known or suspected COVID-19 patients, and use of N95s should be prioritized for these patients.
    • Is there any information or guidance for intraoperative care of patients who are positive for COVID-19 that will protect staff and prevent transfer of the virus?
      • Minimizing the amount of equipment, supplies and personnel in the room is one proven action to prevent transmission. However, each facility will need to develop it’s own protocol based on the number of operating rooms, negative pressure or airborne infection isolation rooms (AIIR), the prevalence of disease in their region, and the availability of equipment and supplies. When surgeries for patients who do not have COVID-19 are performed in the same surgical suite, every effort should be taken to distance these patients.
  • AORN has an online guide for protecting staff and safely managing COVID-19 patients throughout the surgical process entitled “Perioperative Care of the COVID-19 Patient” that is available for purchase. Some guidelines and protocols have been published by the American College of SurgeonsThe Canadian Anesthesiologists Society, and Nebraska Medicine which include:
    • Developing a dedicated COVID-19 OR.
    • Maintaining supply of proper personal protective equipment.
    • If available, utilizing a negative pressure anteroom with separate entrance between OR and main hallway that is used for:
      • Donning and doffing PPE.
      • Placing supplies that are needed after the case begins.
    • Dedicated equipment, anesthesia, and medication carts.
    • Dedicated OR team for COVID-19 patients.
    • Detailed education of perioperative team on infection prevention strategies, including visual reminders.
    • Defined roles and responsibilities of each team member.
    • Thoughtful and judicious preparation for a procedure, with removal of all items not needed before a patient enters the room.
    • Runner outside OR who will retrieve medications, instrumentation, and other supplies.
    • Utilization of mobile telephones to request needed items from the runner and when they are available for circulator.
    • Double-bag specimens.

Finance/Reimbursement/FEMA

  • President signs Consolidated Appropriations Act of 2021
    • Clarification to Provider Relief Fund (PRF) Repayments included in the legislation:
      • Hospitals should use HHS PRF guidance from June 2020 for determining “lost revenue.”
      • Can use current period and budget for determinations.
      • Legislation seems to indicate that lost revenues from only March and April can be applied to Provider Relief Funds.
    • Use of Provider Relief Fund Payments between parent organization subsidiaries is now allowed.
      • If, for example, Hospital A owes PRFs to Hospital B, such excess may be transferred to Hospital B for COVID-19 related expenses and lost revenues.
    • Additional funding for Public Health and Social Services Emergency Fund:
      • $23 billion in funding for COVID-19 prevention, preparation, and response costs.
      • $22.4 billion additional funding for testing, contact tracing, surveillance etc. for COVID-19 suppression.
      • A handful of other changes to reimbursement systems.
  • HHS updates Provider Relief Fund FAQ guidance
    • Phase 3 general PRF payment funding guidance:
      • All providers obtain up to 2% of annual revenue. No payment is made if this amount is already received.
      • 88% of reporting losses and net change in operating expenses.
      • Will not obtain funding if prior PRFs satisfied the above criteria or no change in net revenue.
    • Recipients of Provider Relief Fund payments are required to follow HHS Cost Principles and Audit Requirements for HHS Awards.
      • Guidance found at 45 CFR Section 75:
        • Subpart A
        • Subpart B, subsection 75.303, 75.351 ad 75.353
        • Subpart F
      • By cross reference guidance on financial systems and document retention found at 45 CFR 75, subsections:
        • 75.302
        • 75.361
        • 75.365

Visit the QHR Health COVID-19 Online Resource Center site as often as you’d like as we are providing live news feeds from the CDC and CMS to keep all of us updated on the latest news. There is also a document library link located in the bottom right-hand corner of the page where information is being organized by subject categories.

If you need assistance, please reach out to your QHR Health representative.