AMGA CHRO Council: Shifting HR Policies During the COVID-19 Pandemic

AMGA COVID-19 Resources

Presentation Summary
March 25, 2020

This summary is based on a presentation to AMGA’s Chief Human Resources Office/HR Director listserv as of March 25, 2020. For more information about the CHRO Council, please click here.

Presenters: Mary DeFreitas, B.B.A., M.P.S., Chief Human Resources Officer; and Gaynor Rosenstein, M.S., CMPE, Chief Clinical Operations Officer, Crystal Run Healthcare, Middletown, NY

Mary DeFreitas: Crystal Run Healthcare is a multispecialty physician practice. We also have a management services organization, ambulatory surgery center, and health plan, which are all separate entities. We are a physician organization run for profit. Montefiore Medical Center has a majority share. We have 2,600 employees—450 of whom are providers (including APPs), and we are nonunion. We have 50 specialties. We have 750, 000 square feet of office space and geography-wise, we have offices 30 miles from New York City. Middletown, New York, is our hub. Our largest office is 128,000 square feet. We have 350,000 distinct patients, and we have 2 million patient visits a year (6,000 patients a day). Our call center last week had over 63,000 calls, and 54,000 of them were for the COVID call queue. We have had a decrease of 25% in staff.

About five-to-six weeks ago, our CMO, who has a military background (rally these troops quickly in your organizations), raised the issue of COVID at an executive meeting and laid down the law to be prepared for it coming our way.

Gaynor Rosenstein: So far, we have tested almost 1,200 patients, 919 were negative and 182 positive, so we have a 16% positive rate.

I am going to talk to you about the speed with which we have been working here. We have three separate stages: Stage one was the first two weeks and this is the ambulatory stage. Stage two is dominated by the acute hospital phase, and stage three is the chronic phase. We are moving out of stage 1 and into stage two.

Stage One
Stage one was mobilizing in terms of COVID screening and triage. We had phone screening triage, triage on entry to buildings, a physical barrier to all buildings, and physical segregation of patients. We have 16 outdoor evaluation sites, and they each see 40 patients a day and are scheduled out at least a week. The sites are made up of a majority providers and APPs, who see patients in their cars. These evaluation sites are tent-like structures with one provider in full PPE, a scribe, and an MA. We also have a runner who empties the garbage and cleans instruments.

These sites are completely outdoors. We chose a 1,200-square-foot building that had a round parking lot to set up this evaluation site. The patients pull in and they are given instructions to pull up to tent 1, 2, 3, 4, 5, or 6 to then have their evaluation in the car. We have five sites offering this, and 16 providers who work a full seven days a week from 8:00 a.m. to 5:00 p.m. For protection of staff, we have PPE in phase one and implemented centralized employee health management for symptoms and exposure. This is a core group that we re-deployed; endoscopy, for example, are now part of this group.

Stage Two
Stage two is monitoring CDC changes. We are looking for PPE everywhere, and we are in touch with lawmakers and regulatory agencies to try and get PPE. Gowns, masks, and gloves are now on back order. PPE is now a day-to-day issue.

We are limiting the number of patients seeing staff. We moved hundreds of staff to work from home, which was a big lift on the IT side. More than 300 people are now working from home. We are also practicing social distancing—we have spread-out work spaces. We are not using N95 for staff, but using surgical masks. We also have lots of people making the masks.

We instituted that all sites have remote check-in. Patients will call from their car to check in and the nursing staff will then call them when they are ready and meet them at door and take them to a room, so there is no one in waiting areas. We are also looking at alternative visit types. We have a massive telehealth strategy—50% of visits—with 300 providers. We are using Zoom for this. We have trained all other clinical teams on how to use Zoom. We also have a quick-check station in phlebotomy areas so we are taking weight and blood pressure so that we have it for telehealth visits. We are trying to get our home visit program off the ground this week. All of these things have literally been rolled out within five days.

In stage two, hospital surge planning becomes critical. In stage one, we had a very savvy nursing director who is stationed full time in the county 911 emergency center. She is the liaison for the public health department and local hospitals. For stage two, we are revisiting all contractual obligations and organizing backup plans for our hospitalists. Our providers (physicians and APPS) are anticipating a massive surge in this area, and we are identifying providers for potential deployment. It’s not beyond the realm of possibility that we will have a draft soon. Many buildings will serve as hospitals and hospitals are being asked to increase their capacity by 50%. In Crystal Run, we are evaluating what we can do and who we have so that we have a hospital surge plan (full of providers’ specialties and skills) ready to deploy if needed. Today, it is our priority and we are trying to be ready for the surge to begin at the end of this week and beginning of next week.

Testing has been very difficult. We are currently using Quest and they deliver swabs. We are testing about 500 patients a day. I hope you have a good rep for your reference swabs because ours has literally been driving them to us every day. We hope that at the end of this week, we will bring that in-house. We have instruments that are FDA approved for testing; this is a very breakeven effort, but we would have a faster turnaround. Right now, we are running about 48 hours for testing time. We have a central core lab that runs 30,000 tests a week. We would have a 24-hour shift to run tests continuously to get turnaround time under 24 hours. Patient follow-ups are telehealth following COVID testing. We have centralized recording for results. We have a standard report that comes out every day with test results, and a team is calling our patients so providers don’t have to. At the same time, this team is scheduling telehealth follow-ups. We feel like the episode of Lucy and the chocolate factory.

On the communications side, our CEO has been giving frequent correspondence both internally and externally, and we have gotten a lot of praise for that because we are emailing all patients frequently and we are on social media. Even though we don’t know the answers, we are being really transparent. We have also designated our CMO to be the single source of truth, and this is critical. We are an email-centric organization and people will spin out over email. You need someone who everyone listens to, who calms the water and keeps the hysteria at a low level in regard to staff. Communication internally and externally you can’t do enough.

The other thing is: IT has been great, and our business intelligence team has been doing hourly reports on quarantine, financial indicators, and testing. Regarding the financial piece, in stage one we were securing additional lines of credit very early on, and in stage one and two we are mitigating the financial impact of this on different scenarios; we are not spending anything unless it is mission critical. Montefiore is helping us secure some assistance. Our message going forward is we want to get through this together.

This is a good segue to the HR piece. What I want to get across is you might not be in a crisis area and these are the things you need to be prepared for.

Mary: Timing is everything. Last fall, we made the decision to move our record keeper to Transamerica for our 401K. On March 5, the plans went blackout at 4:00 p.m., and our plans are still in blackout. We have the stress of all this and the stress of all employees not being able to take a look at their 401K balance. We hope to be out of blackout at the end of this week.

Gaynor mentioned employee health, and that department has tripled in the last week and will grow more in the next couple of weeks. We have daily logs of who is going out on quarantine and their expected back-to-work date. We keep track of the exposure here at work and indirect exposure on quarantine because this ties into new pay policies we had to put into place.

We are trying to balance the reduction of patient visits and where we can reduce staff and move them to other areas. We are offering the staff a two-week voluntary leave of absence for which we will continue to cover their benefits. In New York, the schools are closed and kids are home, which is really stressful for employees. We are looking at the redeployment of staff—certainly telehealth, call center, and employee health.

For those in the HR world today, one of challenging pieces is making sure we maintain compliance with changing laws. Jackson Lewis is our labor lawyer, and they have a 57-attorney COVID team that we are in contact with daily. Some of the laws are changing. For instance, the paid sick leave law and Matilda’s Law. Matilda’s Law is for those individuals who are over 70 or have a compromised immune system or have underlying health issues. Depending on how you interpret it, they basically can be/may be/should be/should not be here.

  • There are new pay policies, so we have new leave codes and pay codes in our system to monitor that.
  • In terms of our credentialing department, in New York State you can work even if you don’t have a state license. APPs don’t have to have the same level of supervision anymore.
  • For benefit administration, as you put people out on leave and they are no longer active, what’s your obligation to provide health insurance coverage if they aren’t actively working? We worked out a plan with our carrier until May 31 that employees can still be active and not trigger anything even if they are not working.
  • In regard to payroll concerning workers comp: If payroll goes down, we will adjust our payroll with our carriers so our premium adjusts as well.
  • Physician recruiters: What we thought we needed today and what we will need in 2021 will be different, so we are adjusting this on the fly as we need to do so.
  • One of the things that many people think can be put to the side is employee wellness, but don’t do it. People are scared to do their jobs, and you have to make sure you balance that and keep people healthy. We are posting resources online, such as emergency daycare, for employees, and our education department is doing mindfulness training and stress reduction.

We are tracking our expenses in labor and materials in case the government will help with them. We had folks that cleaned out all Home Depots for COVID evaluation stations (car port tents). We also bought heaters for tents. We are also tracing labor expenses that you can tie directly to these things. We have seen a huge spike in FMLA applications; dozens coming in every day. You need to get people not currently involved in leave management up to speed on how to do that.

Lock up all your stuff because people are going into the bathroom and stealing toilet paper, people have stolen PPE, and people have stolen hand sanitizer. How you manage it is up to you, but it is walking out.

Question 1: Have you implemented or are you considering implementing hazard pay for team members?

Mary: This has come up, but it is not something we have decided is the direction we want to go yet.

Question 2: Could you clarify your quick check stations?

Gaynor: Not sure if that will be the final name of them. Quick check is when people need to come into the building for blood work, so we deploy an MA and have retrained our phlebotomist to take blood pressure and weight and enter them into our EMR so we have this current. That way, when a physician goes to do a telehealth visit, they will have the most recent weight and blood pressure.

Question 3: When you say you would cover benefits during the two-week leave of absence, does that mean you cover employee costs, so no payroll deduction? Are you requiring use of any paid time-off (PTO)?

Mary: We are offering people to use PTO, and we will take premiums out of payroll as we do now. If they don’t use PTO, we are going to cover the full amount of both the employee and employer portions.

Question 4: What will you do with physician comp if they are on productivity models?

Mary: Good question. We are having conversations about that, and I can’t share right now. We are down to just essential services in New York State. At our organization, everyone has a guaranteed base, so their protection is the guaranteed base, but they may not be getting a productivity bonus.

Question 5: What are you doing with pay for doctors?

Mary: Right now, we haven’t made any changes to comp, and it is all based on the contract.

Question 6: With older workers who don’t want to come to work, are you offering an early retirement incentive, and if so, how does it work?

Mary: No early retirement incentive, but if they are over 70 and not comfortable coming into work, we are offering them a leave of absence without pay or they can take PTO, and right now we are covering benefits for them.