COVID-19

WHAT PHYSICIANS NEED TO KNOW (updated July 8, 2020)

Get up-to-date information on what you need to know, links to financial resources for your practice, as well as key Texas Medical Board waivers and guidance.

Practice Viability in the Wake of COVID-19
Financial Resources for Your Practice
Human Resources
Telemedicine
Coding
Additional Resources
PPE
Testing and Treatment
Contact Tracing
Disaster Preparedness and COVID-19
Physician Wellness and COVID-19
What Members Need to Know
What Patients Need to Know
Venturing Out?

Practice Viability in the Wake of COVID-19

Gov. Abbott Restricts Elective Hospital Surgeries in Harris County (June 26, 2020)
- TMA statement - Governor's order GA-27 does NOT apply to ambulatory surgical centers or physicians' offices (June 26, 2020)
Growing Your Patient Base During COVID-19-What Can Be Done? (May 28, 2020)
COVID-19 Sample Letter to Patients - Safety and comfort assurance in the office. (June 11, 2020)
TMA Road to Practice Recovery - A guide for reopening your practice post-COVID-19 (May 11, 2020)
TMA Practice Viability Toolkit (April 7, 2020)
TMA Practice Viability web page
Texas Medical Board COVID-19 Waivers and Guidance (updated July 2, 2020)
Financial Resources for Your Practice
- PPP Loans Reopened - PPP Loans have been reopened until August 8, 2020. (July 8, 2020)
- PPP Loan Forgiveness - New Loan Forgiveness Applications and Instructions. (June 30, 2020)
- Medicaid and CHIP Relief Funding - $15 billion now available to physicians who care for Medicaid/CHIP patients. Deadline to apply is July 20, 2020. (July 6, 2020)
- Emergency Relief Funding - If you received a direct deposit from HHS back in April, you need to attest to the deposit within 90 days of the money being placed into your account. (June 8, 2020)
  - Summary of the Cares Act (NAGGL, Nat'l Association of Gov't Guaranteed Lenders-the SBA Lenders, March 29, 2020)
- The Employee Retention Tax Credit - A tax credit for a business that is fully or partially suspended by government order due to COVID-19. The credit is equal to 50 percent of qualified wages up to $10,000 paid to an employee between March 12, 2020 and Jan. 1, 2021, including qualified health plan expenses. (April 15, 2020)
- Reimbursement for uninsured COVID-19 testing and treatment - Payment for testing and treatment for uninsured individuals with a COVID-19 diagnosis on or after Feb. 4 is available through the CARES Act. (April 30, 2020)
- COVID-19 SBA and other Loans and Advances (updated May 15, 2020)
  - SBA Express Bridge Loans - Enables small businesses that currently have a business relationship with an SBA Express Lender to access up to $25,000 quickly.
  - SBA Debt Relief - The SBA is providing a financial reprieve to small businesses during the COVID-19 pandemic.
  - Main Street New Loan Facility - Effective April 9, 2020. Up to 10,000 employees. Has a 4 year maturity, amortization of principal and interest deferred for one year and minimum loan size of $1 million. (April 13, 2020)
- Information for Tenants concerning Commercial Leases and COVID-19 (Texas Realtors, April 7, 2020)
- Small Business Owner's Guide to the CARES Act (Stimulus Package) (U.S. Senate Cmte, April 6, 2020)
- Coronavirus Emergency Loans Small Business Guide and Checklist (U.S. Chambers of Commerce, updated April 1, 2020)
- Use Guide to Take the Right Steps for Your Practice's Finances (TMA, April 2, 2020)
- This Can Help Your Practice's Revenue During COVID-19 (TMA, April 2, 2020)
- SUSPENDED April 27, 2020 - CMS (Medicare) Interest Free Accelerated Loans - This is a zero interest advance on your fee-for-service Medicare claims. Pay back starts 120 days after payment is received. Review FAQs and complete Request Form.
  - Accelerated and Advanced Payments Fact Sheet (CMS)
  - Payment Request Form for Part B Jurisdiction H (Novitas)
Human Resources
- COVID-19 Human Resource FAQs (TMA, March 27, 2020)
- Emergency Families First Coronavirus Response Act (Staff Paid Time Off)
- From the EEOC - Pandemic Preparedness in the Workplace and the Americans with Disabilities Act - For info on what an employer can require of employees during a pandemic, refer to Section III ADA-Compliant Employer Practices for Pandemic Preparedness; see item B. During an Influenza Pandemic, which begins on page 8. (May 11, 2020)
Telemedicine
- Telemedicine/Telehealth (HCMS) with emergency declarations
- Feds Approve Texas' Request for COVID-19 Medicaid Waiver (TMA, March 31, 2020)
- DEA provides new guidance allowing physicians to prescribe buprenorphine via telephone (DEA, March 31, 2020)
Coding Guidelines
- ICD-10 COVID-19 Coding Guidelines
  - WHO established new ICD-10 Code for COVID-19 (U07.1, 2019-nCoV acute respiratory disease)
  - For cases where there is a concern about possible exposure but is ruled out after evaluation (Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out)
  - For cases where there is an actual exposure to someone who is confirmed to have COVID-19 (Z20.828, Contact with and (suspected) exposure to viral communicable diseases)
  - Additional coding guidanc e
Additional Resources
- TMA COVID-19 Resources web page (April 2020)

PPE

TMA has created a portal for physicians to request state-acquired PPE.
Contact the TMA Knowledge Center at (800) 880-7955 for details.
- For more information on PPE Distribution, see TMA's PPE Distribution FAQs. (updated May 15, 2020)
How to identify counterfeit N95 masks
- Counterfeit Respirators/Misrepresentation of NIOSH approval - CDC (updated June 15, 2020)
- Counterfeit Masks Reaching Frontline Health Workers in US - AP (May 13, 2020)
COVID-19 Personal Protective Equipment (PPE) Supply and Shortage FAQs (updated April 2020)
COVID-19 Infection Prevention and Control FAQs (updated June 16, 2020) and a podcast with tips on how to minimize exposure (April 1, 2020)
CDC Strategies to Optimize the Supply of PPE
FDA Identifies Respirators Which Can Be Decontaminated and Reused

Testing and Treatment

Testing in Houston and Harris County:

The Texas Division of Emergency Management is offering free drive-thru testing. Visit txcovidtest.org or call 512-883-2400. Health care workers will screen people for fever, chills, cough, fatigue, body aches, muscle or joint pain, shortness of breath, sore throat, headaches, nausea, vomiting, diarrhea, nasal congestion and loss of taste or smell.
- Free testing is being conducted at the following locations or until capacity of 250 tests is reached:
  - HCC - South Campus, 1990 Airport Blvd, July 6-11, 8 a.m. - 4 p.m.
  - HCC-Northeast Campus, 555 Community College Drive, July 6-11, 8 a.m. - 4 p.m.
  - Eden Event Center, 7450 N. Wayside Drive, July 6-11, 8 a.m. - 4 p.m.
  - NRG Park, Green Lot, 1 Reliant Park, July 6-11, 8 a.m. - 4 p.m.
  - Merfish Teen Center, 9000 S Rice Ave, July 5-11, 8 a.m. - 4 p.m.
- Appointments are required. Visit txcovidtest.org
United Memorial Medical Center (UMMC) has weekday testing at drive-thru and walk-up testing sites. No appointment is required. For assistance, call 1-866-333-COVID or visit ummcscreening.com. smell.
- Southwest Multi-Service Center, 6400 High Star Dr., 9 a.m. - 4 p.m.
- HCC-Southeast Campus, 6815 Rustic St., 9 a.m. - 4 p.m.
- UMMC Tidwell, 510 W Tidwell Rd., 9 a.m. - 4 p.m.
- Forest Brook Middle School, 7525 Tidwell Rd., 10 a.m. - 5 p.m.
- Cullen Middle School, 6900 Scott St., 10 a.m. - 5 p.m.
- Griggs School, 801 Regional Park Dr., 10 a.m. - 5 p.m.
Harris County Public Health (HCPH) encourages residents to get tested for COVID-19 if they feel they have it or have been in contact with someone who tested positive. Harris County is prioritizing first responders and healthcare professionals, especially those who work with vulnerable populations such as nursing homes. To sign up for COVID-19 testing, please visit http://covcheck.hctx.net/ to be screened or call 832-927-7575.
Houston Health Department (HHD) is offering free testing. Call 832-393-4220 between 9 a.m. to 7 p.m. You will receive an access code and directions to the nearest site.
Free testing is also available at community partner sites.
Select Walgreen's pharmacies have started testing for COVID-19. Patients can go to www.walgreens.com/findcare/covid-19/testing?ban=covid_testing to be screened.
Kroger is offering testing from 10 a.m. to 5 p.m. or until daily testing capacity of 175 is reached. Appointments are required by visiting https://www.thelittleclinic.com/drivethru-testing.
CVS is now offering testing. Appointments are required by visiting cvs.com/minuteclinic/covid-19-testing.
Walmart is offering testing. Appointment required by visiting DoINeedaCOVID19test.com.
Sign up for Houston Area Health Alert Network (HAN) to get the latest update.
COVID-19 Testing FAQs (updated June 18, 2020)
COVID-19 "How To" Testing Guide (June 16, 2020)

Treatment

COVID-19 Treatment FAQs (updated June 23, 2020)
NIH Treatment Guidelines (Updated July 6, 2020)
ALERT -- Severe Illness Associated With Using Non-Pharmaceutical Chloroquine Phosphate to Prevent/Treat COVID-19 (CDC)
Convalescent Plasma Treatment
- Providing Convalescent Plasma Treatment of COVID-19 (Gulf Goast Regional Blood Center)
- Deployment of Convalescent Plasma for the Prevention and Treatment of COVID-19 (Journal of Clinical Investigation)
Release from In-Home Isolation Guidance (TxHHS, March 23, 2020)

Contact Tracing

As physicians, you play an important role in stopping the spread of COVID-19. One essential tool is contact tracing. This begins with a positive test.

Physicians are encouraged to advise their COVID-19 positive patients to contact the local health departments to start the contact tracing process. Patients will be much more likely to respond positively to a request from their physician than an unknown individual calling from the health department.
Patients can call the Harris County Public Health at 832-927-7575 or the Houston Health Department at 832-393-4220.
If a patient does not call, the local health departments will reach out to the individual after the health department receives a report of their positive test.
Patients should make a list of those individuals with whom they have had close contact starting from 48 hours before illness onset or 48 hours prior to positive test for asymptomatic patients.
- Close contact is defined as contact within six feet for 10-15 minutes of another individual who has tested positive.
- The CDC does not recommend differential determination of close contact for those using fabric face coverings.
- However, considerations should be taken if one or more of the individuals wore a N95 respirator.
Those who have had close contact with a COVID-19 positive person should stay at home, maintain social distancing, and self-monitor until 14 days from last date of exposure.

Additional Resources
Harris County Public Health Contact Tracing
CDC Guidance for Contact Tracing
COVID-19 Contact Tracing Starts with You in the Exam Room -- TMA

Disaster Preparedness and COVID-19

HCMS has developed a Disaster Preparedness guide that outlines the steps for developing a crisis plan and connects you with the appropriate government agencies and health organizations for additional needed resources and information.
For further assistance with disaster preparedness:

Physician Wellness and COVID-19

HCMS Physician Wellness Program can get you connected to psychiatrists and psychologists who can provide needed help. Call HCMS at 713-524-4267 and ask for the Physician Wellness Program. This program is not a solution for emergencies. If you’re thinking about suicide, or are worried about a colleague, call 911 or your local emergency department.

Articles

Additional Resources

COVID-19 24/7 Support Line and Resources -- Call 833-989-1919 (Harris Center for Mental Health and IDD)
Fighting COVID-19: A Guide for Hospital Workers (Center for the Study of Traumatic Stress)
Sustaining the Well-Being of Healthcare Personnel During Coronavirus (CSTS)
Coping With the Psychological Impact of COVID-19 (Physicians Practice)

Hotels with special rates for HCMS physicians and their staff (updated April 7, 2020)

COVID-19 Personal Resources
HCMS has gathered together a list of resources to help physicians meet their personal needs, as they deal with the challenges of COVID-19. These resources range from free dry cleaning services to free tutoring for kids.

WHAT MEMBERS NEED TO KNOW

Postponed Events:

April 4 - Business Expo - Will be rescheduled to the fall. Date TBD.

Favorite Healthcare Staffing

Favorite Healthcare staffing is prepared to assist facilities facing increased patient census due to the COVID-19 pandemic.
- All specialties of Registered Nurses, LPNs, CNAs, and Advanced Practice professionals
- Respiratory therapists, case managers, social workers. and other Allied Health professionals
- Non-clinical staff including environmental services and materials associates

WHAT PATIENTS NEED TO KNOW

How Is COVID-19 spread?

It is primarily spread from person-to-person through:

Close contact within approximately six feet;
Respiratory droplets produced by coughing or sneezing.

What are the symptoms of COVID-19?

It is an upper respiratory illness that causes the following symptoms. It can take as little as two days, or as long as 14 days for symptoms to appear.

Fever
Cough
Shortness of breath or difficulty breathing
Chills
Muscle pain
Sore throat
New loss of taste or smell

The list is not all possible symptoms. Other less common symptoms have been reported, including gastrointestinal symptoms like nausea, vomiting, and diarrhea.
A significant porting of people with COVID-19 are asymptomatic.

Venturing out?

With businesses reopening, you might be looking for ways to resume daily activities. Here are some things to consider:

How many people will you interact with?
Can you keep 6 feet of space between you and others?
What’s the length of time you will be interacting with people?

Additional Guidance
Errands and Going Out — CDC

Risky Activities during COVID-19

TMA has developed a chart which identifies the level of risk associated with everyday activities.

The level of risk was created by Texas physicians on the TMA COVID-19 Task Force. See the chart for details.

For Questions, Contact Your Local Health Department

For Houston residents:
832-393-4220 - Houston Health Dept COVID-19 Call Center (Weekdays, 9 a.m. - 7 p.m. and Saturday, 9 a.m. - 3 p.m.)

For residents outside the city limits:
832-927-7575 - Harris County Public Health COVID-19 Call Center (Daily, 9 a.m. - 7 p.m.)

How Can You Help? Give Blood Today

In order to maintain an adequate blood supply, healthy and well people should donate regularly. If you want to be a blood donor, contact the Gulf Coast Regional Blood Center to set up an appointment at a facility near you.