On April 6, 2020, the U.S. Department of Health and Human Services (“HHS”) Office of Inspector General (“OIG”) issued a report summarizing OIG’s interviews with hospital administrators across the country on COVID-19. The interviews, which Hall Render summarized in a previous alert, were conducted between March 23 through March 27 and focused on three key issues facing hospitals during the current crisis, including: 1) challenges responding to the COVID-19 pandemic, 2) strategies to mitigate the challenges, and 3) needs for government assistance. OIG collected this information as an aid for HHS as it continues to lead efforts to address the public health emergency and support hospitals and other first responders. In addition, hospitals may find the information about each other’s strategies useful in their efforts to mitigate the challenges they are facing.
A copy of OIG’s report, Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020 can be found here (“OIG Report”).
OIG also indicated that it was its intent to provide a national snapshot regarding how the 323 surveyed hospitals were responding to the COVID-19 pandemic.
Not surprising at all, the hospitals reported significant challenges in the following areas:
- Severe shortages of testing supplies and extended waits for results;
- Widespread shortages of personal protective equipment (“PPE”);
- Difficulty maintaining adequate staffing and supporting staff;
- Difficulty maintaining and expanding hospital capacity to treat patients;
- Shortages of critical supplies, materials, and logistic support;
- Anticipated shortages of ventilators;
- Increased costs and decreased revenue; and
- Changing and sometimes inconsistent guidance from federal, state and local authorities.
A common theme among hospital administrators is their struggle, not only with supply chain disruption, but also with sharp increases in prices and the concern about the quality of the products being delivered. The challenges that administrators described are exacerbated in the COVID-19 pandemic because, unlike a disaster where the surge is over in a matter of days, with this situation hospitals have to prepare for this crisis to potentially last many months.
Because resolving these challenges is vitally important to patient care, the health of our communities and the financial viability of many hospitals and healthcare providers, OIG’s Report goes on to describe how the surveyed hospitals are mitigating the challenges posed by the pandemic, including:
- Securing necessary PPE, equipment and supplies:
- Using non-traditional sources of PPE, such as online retailers, home supply stores, paint stores, autobody supply shops and beauty salons.
- Using 3D printers and office supplies to make PPE (e.g., masks).
- Repurposing masks from other industries such as dentists, veterinarians, construction workers, nail salons, etc.
- Purchasing expired PPE.
- Ensuring adequate staffing:
- Supplementing medical staff with contractors, retired providers, nurse aides and medical and nursing students.
- Training medical staff to support or play other roles (e.g., anesthesiologists, hospitalists and nurses are being trained on how to operate ventilators and care for patients on the machines; non-ED physicians are being trained in ED triage.)
- Rural hospitals working with other rural hospitals to share supplies and information about vendors.
- Working with the local emergency and health departments (e.g., fire department) to prepare and help with patient flow.
- Supporting staff:
- Assisting staff to find childcare, grocery and laundry services.
- Providing hotel accommodations to promote separation from elderly family members.
- Expanding Employee Assistance Program (“EAP”) services.
- Managing patient flow and hospital capacity:
- Using ambulatory care clinics in the community and telehealth to triage patients in the clinic, in the car or over the phone to limit ED visits.
- Limiting the number of visitors.
- Constructing temporary walls in the ED to isolate patients and create negative pressure space.
- Establishing alternate care sites at local fairgrounds and other spacious facilities.
- Securing ventilators and alternative equipment to support patients:
- Renting ventilators, buying single-use emergency transport ventilators or obtaining ventilators from an affiliated facility.
- Sharing supplies of ventilators between hospitals.
Additionally, the hospitals provided OIG with suggestions regarding how the government can help hospitals. The hospitals noted that it would be beneficial if the government could intervene and coordinate the provision of testing, supplies and equipment. The hospitals indicated that the government could also provide assistance by simplifying workforce allocation processes, thereby making it easier for providers to realign duties, as needed. The hospitals also asked the government for increased financial assistance and for relaxed rules to allow them to expand their capacity to treat patients. Finally, the hospitals told the OIG that it would be beneficial if the “Federal Government could play a central role in messaging and communications to mitigate what they perceived to be conflicting or inconsistent guidance across levels of government.”
OIG is gathering important information that can be used by hospital administers nationwide to create solutions for care delivery. CMS’s and OIG’s waivers are also providing much-needed relief and are, to a great extent, responding to many of the challenges described above. The information OIG is gathering may also aide hospitals down the road when regulatory compliance issues arise and hospitals and health care providers may be called on to support their particular actions during the public health emergency.
If you have any questions or would like further information on this topic, please contact:
- Katherine Kuchan at (414) 721-0479 or kkuchan@wp.hallrender.com;
- Scott Taebel at (414) 721-0445 or staebel@wp.hallrender.com;
- Kenneth Zeko at (214) 458-3457 or kzeko@wp.hallrender.com; or
- Your regular Hall Render attorney.
Hall Render’s attorneys and professionals continue to maintain the most up-to-date information and resources at our COVID-19 Resource page, through our 24/7 COVID‑19 Hotline at (317) 429-3900 or by contacting your regular Hall Render attorney.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
