COVID-19 Updates

May 13, 2020

Governor Wolf Issues Limited Medical Liability Immunity Order with Narrow Application

On May 6, 2020, Governor Tom Wolf issued an executive order to limit the medical liability of physicians and facilities directly responding to the COVID 19 pandemic. This liability limit is narrow in scope and should not be seen by orthopaedic surgeons as blanket immunity for all procedures performed during the declared emergency.

Governor Wolf’s general emergency powers allow him to suspend, in part or in whole, certain statutes, but does not authorize him to create new laws. Also, current law grants civil liability immunity to any Commonwealth political subdivision, agency, employee or agent who is providing emergency services during a disaster. Therefore, in his May 6 executive order, Governor Wolf designated certain healthcare workers and facilities as “agents of the Commonwealth solely and exclusively for purposes of immunity from civil liability due to emergency services activities or disaster services activities only as related to the Commonwealth’s COVID-19 disaster emergency response” regardless of their pre-emergency status.

The executive order specifically applies to any individual licensed professional; any licensed healthcare facility; or any alternate care site, community-based testing site, or non-congregate care facility engaged in COVID 19 emergency response.

This immunity grant is not absolute. The executive order states that liability will attach, “in the cases of willful misconduct or gross negligence, to the fullest extent permitted by law.” In addition, the executive order states, “this grant of immunity shall not extend to health care professionals rendering non-COVID-19 medical and health treatment or services to individuals.”

PAOrtho advises members to consult your practice’s or facility’s legal counsel to properly assess the executive order’s application to your actions during the declared emergency.

Read the executive order

Nearly all other executive orders issued by Governor Wolf have been legally challenged. Thus far, his emergency powers have been sustained by the Pennsylvania Supreme Court and the United States Supreme Court. As of this writing, no litigation has been initiated regarding this limited medical liability immunity executive order. PAOrtho will continue to monitor any challenges.

Sincerely,
Jonathan Garino, MD, MBA
President, Pennsylvania Orthopaedic Society


May 6, 2020

Is Opioid Abuse on the Rise During the COVID-19 Pandemic in Pennsylvania?

During the COVID-19 Pandemic, the Pennsylvania Orthopaedic Society continues to advocate for you, your practice, and your patients. Among the many crises the Pandemic has caused in our lives and practices, another area of growing concern is increased opioid demand and potentially abuse in our communities. See this recent report from York County.

In an effort to better improve our understanding and subsequently assist through education and advocacy, the Pennsylvania Orthopaedic Society would like to hear from you.

Please consider completing this simple two question survey: https://www.surveymonkey.com/r/X9FM6W9


April 28, 2020

New ASF Elective Surgery Guidance

While Pennsylvania remains weeks away from “normal” economic activity, the Wolf Administration took a large step toward returning medicine to normalcy. On April 27, Health Secretary Rachel Levine announced new guidance to lift the March 20 prohibition on elective surgery.

Effective immediately, acute care hospitals and ambulatory surgical centers (ASF) may begin performing elective surgery if the hospital or ASF “makes an affirmative decision that it is able to do so without jeopardizing the safety of patients and staff or the hospital’s ability to respond to the COVID 19 emergency.”

GUIDANCE ON AMBULATORY SURGICAL FACILITIES’ RESPONSES TO COVID-19

GUIDANCE ON HOSPITALS’ RESPONSES TO COVID-19

PAOrtho continues to work on a myriad of advocacy issues including medical liability limitations for COVID 19 response treatment and preauthorization reform. Your continued support of the Society is critical to our success.


April 14, 2020

PPE Inventory Portal & FAQ

Pursuant to Governor Tom Wolf’s April 8, 2020 Executive Order regarding PPE inventory, please view the state Department of Health’s Frequently Asked Questions publication. Your practice or surgery center may find this information helpful in determining your obligations under the order.

Also, below please find a link to the inventory reporting portal.
https://arcg.is/1PPbjL0


April 9, 2020

Wolf Executive Order Requires PPE Inventory Reports; Authorizes Commandeering of Medical Resources

As Pennsylvania approaches the COVID 19 emergency apex, on Thursday, April 8, Governor Tom Wolf issued a new executive order to ensure critical care hospitals can access Personal Protective Equipment (PPE), pharmaceuticals and other medical resources, if necessary. Healthcare facilities and providers are required to report an inventory of their medical supplies to the Pennsylvania Emergency Management Agency (PEMA) within five days. PEMA is authorized to commandeer and transfer supplies to the Commonwealth’s hardest hit regions. Medical resource manufacturers, distributors, and suppliers are subject to the order as well.

In the order, Governor Wolf stated that, “despite the voluntary efforts of healthcare providers and despite the exhaustive work of Commonwealth agencies to procure PPE and other medical resources from private industry to support Pennsylvania’s healthcare workers, facilities, and emergency responders, a critical shortage of PPE, pharmaceuticals, and other medical resources remains.”

To date, the Commonwealth expended $24 million to acquire PPE and other medical resources from the private market. In addition, hospitals, and most skilled nursing facilities, signed a Statewide Healthcare Mutual Aid Agreement to allow the transfer of supplies, staff, and information across regional boundaries. While these efforts have been beneficial, Pennsylvania, like many other states, faces a critical PPE shortage given current COVID 19 pandemic models.

Ambulatory Surgical Facilities (ASFs) have been subject to the inventory requirements since March 20. The new order expands the inventory reporting to all healthcare facilities and providers.

Governor Wolf’s executive order is viewed as prophylactic in nature. The Administration is taking this action now instead of waiting for a PPE crisis to sweep across the state. Below, please find a link to the new order:

https://www.governor.pa.gov/wp-content/uploads/2020/04/20200408-GOV-Critical-Medical-Resources-Order.pdf


April 3, 2020

PAOrtho Responds to COVID 19 Pandemic

As the COVID 19 pandemic gripped the Commonwealth and the nation, PAOrtho actively pursued measures to ensure your patients can continue to receive high quality orthopaedic care and your practices do not need to remain shuttered. This update is extensive, but captures our many endeavors on your behalf.

Ambulatory Surgical Facilities
Over the past three weeks, PAOrtho, in conjunction with the Pennsylvania Ambulatory Surgery Association, diligently worked to ensure that ambulatory surgical facilities could reopen to treat patients in need of urgent care. Through this joint effort, the Pennsylvania Department of Health (DOH) revised its March 20th guidance thus allowing otherwise healthy patients to receive care in ASFs rather than risk COVID 19 exposure at acute care hospitals.

In relevant part, the April 1st revised guidance states:

Elective Surgeries and Procedures (Revisions in red)
ASFs must review all scheduled elective surgeries and procedures and develop and implement a plan to postpone or cancel those surgeries and procedures if they have not done so already. After 11:59pm on March 20, 2020, ASFs may not perform any elective surgeries or procedures unless the surgery or procedure would preserve organ function or avoid further harms from an underlying condition or disease. ASFs must consult CMS’s guidelines on elective surgery and procedure recommendations when making cancellation decisions. Pursuant to 28 Pa. Code § 551.21(d)(4), ASFs may not allow the performance of surgeries to treat emergency or life-threatening conditions to occur in the facility, unless no hospital is available for the procedure and the need for the surgery could not have been anticipated.

ASF Mandatory Survey (Entirely new provision per April 1, 2020 revision) 
Pursuant to the Amended Order of the Secretary of Health, issued on April 1, 2020, all facilities licensed as ASFs, including those that have suspended services, must complete and submit an initial survey to the Department. All fields must be completed for the initial submission. For ASFs that have not suspended services in response to COVID-19, the ASF must complete the fields of the survey indicated to be mandatory at 0800 on every day the ASF is in operation. Further, if any nonmandatory field has changed from the initial submission, the ASF must update that field on the next calendar day’s submission. An ASF that has reopened after a period of suspended services must complete the survey on the first day of its reopening and every operational day thereafter, in addition to the other reporting requirements described in this Guidance.

DOH will also continue to require ASFs to daily report inventories of surgical and personal protective equipment. Please review the full revised guidance below:

Amended Order of the Secretary of the Pennsylvania Department of Health Requiring Ambulatory Surgical Facilities to Make Daily Reports of Specified Data Regarding Supplies and Equipment

Updated ASF Guidance Regarding COVID19 040120

Physician-owned Hospitals
As the COVID 19 pandemic took hold of Pennsylvania and the nation, physician-owned hospitals (POHs) capacity remained idle due to CMS rules. PAOrtho spearheaded the Pennsylvania effort to influence CMS to lift these POH restrictions by prevailing upon the DOH and the Department of Human Services (DHS) to include POHs in the state’s 1135 Waiver. At the same time, AAOS and Physician Hospitals of America (and their President-elect Fred Liss, MD of the Rothman Orthopaedic Institute) used their muscle in Washington DC to influence the Trump Administration. The combined effort yielded a March 30th blanket waiver that allows POHs to expand their bed capacity during the emergency. Please see a link to the waiver below:
https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

Pennsylvania COVID 19 Working Capital Access Program
At the state level, the General Assembly passed and Governor Tom Wolf signed into law the COVID 19 Working Capital Access Program. Business, including orthopaedic practices, with 100 or fewer full-time employees may be eligible for $100,000 12-year loans at 0% interest. The Commonwealth has made $50 million available for this program. To review the criteria and apply, please go to: https://dced.pa.gov/programs/covid-19-working-capital-access-program-cwca/

Federal Paycheck Protection Program
The federal government likewise authorized a nearly $350 billion program to provide forgivable loans to small business with 500 or fewer employees. Under this program, eligible businesses, including orthopaedic practices, can receive an amount up to 2.5 times the cost of payroll for eight weeks. Other eligible expenses include utilities and rent or mortgages. As long as the loan is used for eligible expenses, loans will not have to repaid nor will they be taxable. To learn more, please go to: https://www.sba.gov/funding-programs/loans/paycheck-protection-program-ppp

As the COVID 19 emergency continues, please be assured that PAOrtho continues to advance other vital practice issues and to advocate for our legislative agenda. Your membership continues to be important to your patients and your practice. Please maintain your membership!

Sincerely,

Jonathan Garino, MD, MBA
President, Pennsylvania Orthopaedic Society