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HCCIntelligence™ Virtual Office Hours Recording: O ...
Open Discussion on COVID-19 Vaccine Administration
Open Discussion on COVID-19 Vaccine Administration
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Speaking of some uncertainty, I think not a day go by without recently both the front offices have commented and also my providers. Everybody's asking about the COVID vaccine, COVID vaccine, and Brianna. Are there any updates regarding reimbursement for vaccination for our patients as we gear up and prepare for for this really this mass effort here. Yeah, so I'm going to talk purely to the billing on vaccine administration and then we'll let our clinician educators and champions and leaders, talk more after we finish our q amp a from the coding in the virtual office hours but the AMA has a great guide, because the vaccines right now are being paid out of federal tax dollars what you're getting reimbursement for is the administration codes, and there's different administration codes for the Pfizer vaccine and there is for the Madonna, then the potential AstraZeneca vaccine so make sure that you know which codes to use for the first dose and the second dose based on the manufacturer. I put the link to this AMA guide as well as the link to CMS his website they have a great web page as well that explains these from a coding and documentation perspective it's important to realize you know although the payments not very high you can see 16 to $28. So all of these things these bullets on the top of your screens, this is included in payment for the vaccine administration so they're expecting that the providers reviewing the patient's chart to confirm you know the vaccine is indicated any sort of counseling specific to the vaccine, just to the vaccines risk and benefits and administration is bundled in that code, you can't build a separate am unless you did some sort of distinct work different management of their diseases, things like that which you're going to be able to do but don't, you know, put a whole in progress note with the chief complaint of coven 19 vaccine administration and think you're going to be able to bill for both for compliance, you want to make sure you're giving them that vaccine information sheet and that fact sheet which you can find on the CMS website as well for these specific vaccines, obviously administering the dose monitoring that patient for that 15 minute period afterwards, and then updating their records so just make sure that you're getting a coding and documentation perspective in the actual vaccine administration billing, and then using the correct codes by the resources that we've provided to you. So, this is going to wrap up our kind of formal presentation and I'm going to kick it back over to our moderator to take it into our virtual office hours. Great. Thank you Brianna and Dr. Chang for a very timely and valuable presentation. As moderator we will now take questions on the main topics of today's presentation until 5pm. At that time we will transition into an open discussion with our panelists where we will share experiences challenges and exchange ideas on coven 19 vaccine administration. The first question that we have for the panelists here today. Are there additional codes, we should be adding to bills, doing home visits in coven 19 times. I can start Paul and then if you have anything to add, feel free to jump in but I would say, not necessarily additional codes but thinking about the telehealth flexibility so billing for those phone calls in addition, you know, in between your visits or, you know, during the pandemic if you're having to have more frequent goals of care conversations advanced care planning can be just a phone call could be audio only. So you want to be thinking about all those extra you know how can this, the flexibilities that we have in place benefit your, your practice. If you're doing an E&M visit related to COVID testing so that the patient doesn't have a copay but not necessarily additional codes but don't forget about all the flexibility that we have right now because of these waivers. Yeah, I agree. Brianna I think, don't forget the telehealth option that's available to us. And the other, and you, you kind of stole my thunder is it is the advanced care planning discussion. A couple months ago, our Northwestern internal billing and coding person reached out to me, because they don't know our patients, we think, you know, we think everybody should know, you know, this is a this is a dom, this is a home, but they take care of so many bills, obviously. So they requested that, in our in our visit note that we document that the patient is seen at a assisted living facility or a group home slash an ALF. So in just for clarity, and in terms of billing for them that they know that the visit was made at such a place and the code that was that was dropped is consistent with the with the side of care. Okay. Next question, can we build TCM, along with CCM. You can now actually as of last year and now they even unbundled the add on code. So yes, transitional care management can be billed within the same calendar period as chronic care management, you just need to make sure you're not double counting anytime like you're not building that time for the TCM interactive contact call is CCM or, you know, that the, the dish, the activities that you're doing regarding that post discharge visit, and that time after admission is billed with the TCM, and then you can add separate time your care management time for other phone calls and things like that as long as you have that documentation. Those can be built together. So that that is a really big benefit that we just got within the last two years. One, one caveat though is because we take care of patients who go to the hospital, frequently, and brand new can correct me if I'm wrong that the TCM can be built only once in a 30 day period of time is that correct. That is correct. Yeah, they're hoping you know by the goal of a TCM program is you're avoiding a readmission but let's say you did a TCM visit and then you had to go back and see that patient again, you know, as a follow up after potentially a second admission and then you just fill your normally and I'm code it doesn't negate you from billing a separate and distinct service that is payable, as long as you're documenting the work that you're doing. So, again, that TCM code is what you bill on that first post discharge visit. You know, and then you can you know you can make a decision on if it makes more sense, you know, to build an EM because you think, you know, or whatever the case may be but you just can't, you know, it's one TCM code per 30 day period. For RPM, how does that work with staff caregivers at ALS. Yeah, so good question. So, the device would actually have to be on the patient right so whatever kind of device you're using, you know, would be, it would be sending you know the patient's vitals or whatever you're recording to you, but if it was a patient with cognitive impairment and their primary caregiver, like you're calling back to okay the blood pressure was elevated and here's my treatment plan. You know, you're, you could certainly be communicating back with a staff member or primary caregiver for the patient it kind of works the same way as patients that have POA is you know chronic care management, you might be talking to a POA, or you might be talking to a home health nurse there's flexibility there. So you just have to make sure obviously the device is on the patient itself the patient is the one that you're developing the care plan for, and you're communicating with the appropriate primary caregiver for that patient. But that would, you know, that would definitely if you're part of a large health system they might want to make a policy on that or something because there, there is always a little bit of gray but you know there's no regulation that says you can't communicate, with a disabled patient with their primary caregiver. Another question been asked a couple times by different people. What is the best way to bill for multiple telephone calls that occur over several days, not related to an EM. So, that's why I'm such a big fan of chronic care management because it's the least restrictive code like there's a lot that goes into CCM implementation so it might seem a little overwhelming at first. But once you enroll a patient in chronic care management you have their consent you've, you know, done the initiating visit if it's a new patient or a patient you haven't seen in 12 months and you and you're, you can count any and all time so every time that you talk about that calendar month you could be adding all those minutes and then billing it at the end of the month. That would be the easiest way. The virtual checking codes and the telephone EM codes would be hard, harder to support you know they separate and distinct services or things like that. So I really think a care management service like chronic care management would would be your solution to that. Otherwise you'd have to think if it was related to an EM visit is this a situation where you might want to use prolonged services or, or, you know, non face to face the 99358 CPT code or something like that. But CCM really is the least restrictive way that you can get paid for any and all medical management time phone calls and not phone calls throughout a calendar month throughout the whole 30 days and then you bill your total CCM time at the end of the month. I want to thank you all for your very thoughtful questions today. I know that we were unable to get to all of them specific to the 2021 coding and billing. I do want to let you know that we will be following up with each of you that attended today with information on where you can find additional resources, but also you can reach out to us via our hotline. Whether that's phone call or email and we will provide that to you as well. So if we were unable to get to your question today. You will be able to submit it there and you will be able to reach Brianna directly and we will also be able to get others involved as needed. So as a reminder, we will have this recording available for today's webinar, as well as the virtual office hours and slide presentation on our ACC Intelligence Resource Center, and we'll be following up here with slides as well as how you can access these materials. With that said, I am going to transition us over to our extended virtual office hours session for today on the COVID-19 vaccine administration. And with that, I'm going to ask our panelists to share their screens. And then we will also be allowing you guys as attendees to now share your screens and unmute yourselves as well. I hear Dana unmuting everybody. I am. Sorry. In the new Zoom world. In the new Zoom world. I just want to say that was such an engaging. I love the conversational nature of Paul and Brianna. For a billing and coding talk, I've never been so attentive. So just a fantastic job. There was just so many wonderful, nice comments that were appropriate. Well, thank you. It's easy to work with both of you. You all know that. It's fun to make a conversation. If I have to sit here and talk to you for an hour about billing and coding, I better at least try and make your eyes not glaze over. So we tried. Best we could. You did. Great job. So I'll continue to let people in here on the call. But what I would like to do is just begin this conversation with everyone here. And I am still letting some of you in. There we had such a large amount of turnout today. But I'm hoping that as we begin this discussion, I know, Dr. Cornwell, I am going to put you a little bit on the spot and have you kick us off. I know that you have a very valuable resource that we have provided on our COVID-19 site. And we'll also follow up with after today's call. But with that said, you want to kind of kick us off with kind of what your world is looking like and what your challenges are, and maybe share some strategies that you are putting into place currently with your practice. And thank you for that. But actually, I'm going to be quite quick because I'm actually going to put Steve Landers. And so what I was basically going to tell you is everything that I learned from Steve. And what an honor that, you know, we contacted Steve this week and actually asked if he could participate in this. He's a real national leader in home-based primary and home health in the country. He leads the largest, or the second largest, Visiting Nurses Association, the Visiting Nurses Association of New Jersey. And so has done some marvelous blogs. I know you're going to give that resource at the end, Dana. And so I really think, because I would have basically been saying what I learned from Steve. And so I'll let you get it. If you don't mind me saying from the horse's mouth, Steve. I think horse's mouth is the biggest compliment I get. It's sometimes the other side that people are mostly attributing to me. And, you know, truly, you know, thank you for getting to connect with all of you and for the kind welcome. You know, I'm coming from several perspectives. So I like Tom said, I serve as the CEO for an organization called Visiting Nurses Association Health Group. And we have several different types of providers within our group that all are sort of in this, you know, how do we deal with these vaccine issues from different perspectives? So we have a home visiting medical group. So about, you know, physicians, nurse practitioners doing home-based primary care. We have home health agencies, so Medicare certified home health agency services. We actually manage federally qualified health centers. So primary care health centers where people come for outpatient primary care. And then also we have a public health agency that's aligned with Medicare as a what they call a mass immunizer, where we're able, you know, we have a billing number to go out and do immunization services, typically in the past influenza. And so for the past month, and I actually wish I had started on it sooner, really been asking the question of myself, my colleagues, everyone, how do we get vaccines, COVID-19 vaccines into the arms of homebound elders? How do we get the you know, how do we how do we get it to people? And this is really more this this conversation is separate from other conversations around community based vaccination, facility based vaccination. Really, it's been more about what about the person that lives in that split level home or the the duplex or the, you know, the tetestroke that needs ambulance transport to get out of the house? How do those people get access to vaccine? And so, you know, I actually, as of Monday, I did my first two home visits where I gave two different patients a dose of the Moderna, first dose of the Moderna vaccine. And I have a couple more scheduled tomorrow. But that's certainly not scalable. And it's not a long, big picture solution, but it's a start. And, you know, the way I look at it, there's kind of a couple of issues that have to be confronted. One is, how do you get vaccine, the product itself? And then how do you get that into somebody's home? And then the other question is, how do you actually make this possible, a scalable business that can actually be done and replicated and happen, you know, across the country? So in terms of getting access to the vaccine product itself, that's really a state by state issue. OK, the vaccine products have been allocated to states and the state governments have their own plans, strategies, approaches to allocating vaccine to hospitals, retail pharmacies, medical groups, what have you. So first thing, you know, if you're thinking about getting vaccine into people's, you know, into the homes, you got to have access to the vaccine. And so at least I understand now from work that my team and I has done how to get access in New Jersey. You know, there's a few different ways you could think about this. Can you work with a hospital or a pharmacy or another provider to get some allocation of what they have? Or can you yourself as a provider apply? All those may be different, may be options in different places. You got to remember the Pfizer vaccine requires like a minus 70 Celsius special freezer to store it in. So not the typical medical group doesn't have one of those. Although if you got it and you could use it within five days, the Pfizer vaccine can be stored in a refrigerator for five days and can be used at room temperature. The Moderna vaccine needs to be stored in a freezer, but not quite as cold of a freezer. So it's one that you may be able to get in your office potentially, although you probably still need special monitoring of the freezer temperatures and backup generator and things like that. So it's not the easiest thing. So you need to get the vaccine. So that's kind of part one, that's a local problem that requires problem solving, calling other providers, coordinating, and then if you've got it, then what about getting it into people's homes? So what I share on my blog is some back and forth that I've had and some other colleagues have had with some of the manufacturers about how long the vaccine products are stable in a prefilled syringe. Right, because if, or how long can you keep the vials out in the community? Pfizer and Moderna vaccine products basically have the same issue. They both say that once the vial is punctured and they're both, well, Pfizer is smaller, it's like four or five dose vial, the Moderna vial is a 10 dose vial. Once it's punctured, you're supposed to use the product within six hours, all the doses in it, or discard it. So, you know, you can imagine if you were a home visiting doc and you had one vial of the Moderna vaccine, which can be transported at room temperature, and you had 10 doses in there and you had to go home to home to give it, it's going to be hard to get 10 doses out, all the observation time, everything else within six hours. You know, maybe in a congregate care setting, maybe in a, you know, urban area, maybe. I don't think so. So that, so the question is about prefilled syringes. So I shared some information, basically the bottom line that I've been able to gather with some help of some colleagues right now is that both the Moderna and Pfizer vaccine, you can transport it and maintain it in a prefilled syringe for the period of time that it was allowed to be in the vial unpunctured. So with it, as long as it's used within six hours of first puncture of the vial, then you can use it. And so the way I actually have done the home visits that I did is I have a relationship with the federally qualified health center. They have an allocation of vaccine from the state. And so basically I did it under the auspices of the health center. I went and did visits in the neighborhood where the health center is located and went there where they have a big clinic where they're trying to, you know, vaccinate a couple hundred people a day. Went in, drew up a couple doses right from the vial, transported them, was able to, you know, get them in somebody's arms within, you know, about 90 minutes of when the vial was first punctured. So those, it worked in that instance. This is not that easy to scale or replicate, what have you. So that's that perspective. And the other side of it is how do we make this actually, and I've heard the Johnson & Johnson vaccine may turn out to be a better option for this. It's going to be single dose. It may have single dose vials. AstraZeneca also may be a better option. Those are going to be eight dose and 10 dose vials that can be stored at room temperature longer. So, you know, those may help, but you know, then the other question becomes, okay, let's say you can get access to vaccine. Let's say you have a population of patients that are relatively geographically clustered, where this issue of only having a few hours to use the vaccine in a syringe isn't a big deal. Well, you know, how the heck are you going to do this from a business standpoint, right? I can do this because I'm employed by a nonprofit organization that does in multiple business lines and, you know, I have a salary and an administrative job and it's, you know, you can do this every once in a while. How the heck would you do this, you know, if you weren't in that situation? Well, I believe in order to get that, make that possible, there's really only a few paths. One is I'm trying very hard to get Medicare to issue another waiver for home health agencies to make it clear that administration of a COVID vaccine could be included as part of a home health plan of care and could be, would be considered a reasonably done billable visit within a home health agency care plan. And so that would be one way to, you know, make it feasible for home health agencies, you know, when appropriate to provide a vaccine, COVID vaccine within the, in the care plan. And then I really think we should all be asking Medicare, quite frankly, to, to address this issue of the E&M codes for the vaccine administration. The way those are set up, they're meant for like, like when I went into the hospital and got my vaccines. Okay. I went there, I got observed in a group of 10 people. Okay, so there was one nurse that was observing 10 people post vaccination for anaphylaxis and other complications. Maybe that $18 code makes somewhat sense in that model. But if you're one-to-one in a home visit, the idea of, you know, $18 for all that documentation, all the state registry systems, and then observation afterwards for 15 minutes, it's just the dollars don't add up. And so I think, you know, we need to ask Medicare and continue to ask them to clarify that during the public health emergency, that billing an E&M code is appropriate for a home-based administration of the vaccine because of all the work that's involved that can't possibly have been considered in making those codes for a home-based care. Those codes are meant for an outpatient setting or a mass immunization setting. They are not sufficient. Now, as an add on maybe to an E&M, if you're already there for another reason, okay, but if you're going to go to a home visit just to do this, it doesn't, the math doesn't work. So those are some perspectives. And those are some of the things that we're working on. I'd be happy to, you know, I feel like I've already probably gone on too far without pausing here. So I'll take a break and, you know, just eager to, you know, try and stimulate more activity. This is hard, but it's doable. Thank you all. All very great points. And as I mentioned, we'll follow up here and make sure that people have access to your blog. I know we were talking prior to the call that I think you started with like an initial blog and now it's turned into right now a three-part series. So it's kind of continued along. And for those of you, when we share it, if you haven't seen it, it is very informative and enlightening. With that said, you know, Paul or Dr. Chang, I would love to hear your perspective. I know you're in a little bit of a different type of model and situation being with Northwestern Medicine. But I'd be interested to hear what you could share here with maybe some challenges you're experiencing and maybe some strategies that you guys are putting into place. Absolutely. Yes, I'm part of NM. And one of the challenges, Steve already talked about this, is how do you get the vaccine? And the analogy I have is waiting at the airport analogy when your flight's delayed and you have no idea why. And the person at the desk can't tell you when the plane is coming and you just have to sit there and wait. And sometimes you fume, right? Let's be honest. Because you have places to go and things to do and you just sit there and they're just, you know, what can you do? So I think one of the frustrations that I'm facing as I'm working with a large health system is that they say, well, it's coming, it's coming. Well, your plane's coming. But, you know, when? What's the holdup? You know, when do I expect a plane to get here? When can I execute the plan that I have to help my patients get vaccinated? So I think there is the initial frustration right there of, you know, getting my hands on on the supply. And the second is logistics. And Steve talked about that already. I again, I met with my staff on Monday beginning to work out a logistical plan. When we get the vaccine, how are we going to do this? We talked about scripting for the front office regarding screening and so forth. We talked about the providers going over the chart, make sure there are no contraindications. And Northwestern has a particular stipulation about 90 days. You have to wait 90 days before you get your COVID. If you had a COVID infection, you have to wait 90 days. So we have to screen for that. We talked about the 10-dose vial or five or six if you're using the Pfizer. How we're going to do that, you know, we're going to huddle at the office and then break the seal, so to speak, and go out. We talked about looking at our schedule and pushing off patients who are stable, perhaps moving them for another month for follow up so that we can get our patients vaccinated. So, again, nothing is set in stone. This is very much a fluid situation and but I encourage you to start thinking about how, once you get the vaccine, how are you going to make this work with the vaccine? Within your office, with your providers, with the resources that you have so our patients can get vaccinated. Two other comments. One is that if we've been encouraging our patients if they live in assisted living and they are getting vaccinated at assisted living, go ahead and get vaccinated there. Don't wait for us. That also will reduce the number of patients that we will need to vaccinate. And I've been also telling my patients, those are semi-homebound, that they're able to get out. If they can get to their Walgreens or CVS, like, you know, we tell them about Shingrix, right? You can get your Shingrix there. If you're able to get out to a local pharmacy, go ahead and get it there. Again, they will have gotten their vaccine, not necessarily wait for my, quote, delayed plane, which may, who knows when it's going to get here. And then it will reduce the number of patients that we will need to vaccinate. The final thing is, you know, I've already worked with my higher ups, the people who are really in leadership here. I have been just asking them several times now, and I think I'm going to stop because I'm becoming a nuisance probably. I said, don't forget our patients. Be your patient's advocate. These are really people without voices, without power. We need to be there for them. I've sent emails, you know, we have a small population of patients. Please don't overlook us. And just periodically remind them of the important need our patients have, and the fact that they have really zero access. This past Tuesday, I saw a couple of new patients. All of them, they're literally bedridden. They cannot get to the hospital when they have a flu, not a flu shot, a COVID fair, or they cannot get to the county grounds when they have a COVID vaccination fair. They cannot get there. You know, we need to speak up for them, be their advocate, and go to the health system and say, you know, we need help. You need to get us these vaccines so we can help our patients. Those are my comments. And Dana, can I ask them too, each a question? Paul, because I don't know if I missed this, but one of the things that I didn't hear from you that I know you told me is when you talked about these huddles, the question I'm going to have for you, and then you can answer it, and then I also have one for Steve that I'll also ask now, is about divvying up the doses. You know, you may have said that if I missed it, but if you could just, you know, let the audience know that. And Steve, when you gave the two, the transportation, the logistics in terms of like temperature, as you know, so you have the six hours, how are you transporting the vaccines during that six hours if you have multiple doses? But Paul, can you first, and I didn't think I heard that because I think it's important for people to hear how you're going to divvy them up to handle Steve's logistics about how do you use 10 doses in a day? Absolutely, Tom. We don't want vaccines to go to waste, right? We also understand that our providers have to travel. The huddle, meaning, let me back up. Some of my providers, when they start their day, they start from home. They never come to the office. They just see patients. They don't want to drive all the way to the office and then go all the way back out and see patients. With the COVID vaccine, for example, if we used a multi-dose vial of Moderna, that's 10 doses. And if my providers needs to go far out west and it's 40 minutes drive just to get to that particular part of the area, you know, that's 40 minutes of time that, you know, that's eating into the six hours that Steve was talking about. So what we're talking about, at least for COVID vaccination purposes, if we're going to break the seal of a 10-dose vial that, let's just say, you know, you're going to be six and four or five and five, as you go to the far reaches that you have a reasonable chance of using up all the vaccines within that six-hour period of time without wasting. That's what I meant when I said, you know, huddle in the office. Normally, we don't always, we don't all come to the office and start our visits. But because of the vaccine issue, the logistics related to this, we may have to temporarily rethink how we do this. And regarding, yeah, I'll let Steve answer the question about the transport. You'll divvy them up between the four of you. And that's how you would, you know, get rid of the 10. And then Steve, transportation requirements? Yeah, so both, you know, the both the Moderna and the Pfizer vaccine, you know, can be maintained essentially at room temperature. And I off the top of my head, I can't tell you the exact temperatures, but it's, you know, I think, you know, maxes out like 70 degrees Fahrenheit, you know, in terms of that six-hour window. So, you know, at least right now in New Jersey, you know, we're well below those temperatures. And, you know, I just basically used a, you know, a little foam, kind of soft, cooler type of thing. And then, you know, had the syringes in a, you know, in a bag inside of that. And I, you know, again, I would totally agree that this is something that should be focused on people who don't have an alternative. If they are in a facility, or even in a, you know, public senior housing or something where there might be a more of a mass vaccination effort, I think that's a much more efficient option. But, you know, there are going to be people that will fall through the cracks, and we need to advocate for them and help them. So, that piece works. You know, the other things to consider that really I thought, you know, Paul started to touch on that are really important would be, you know, pointing out the need here. I think it's going to become more front and center for leaders, so they might want to be proactive. I've had several members of Congress, their offices, reach out about this issue and wanting to know how their homebound constituents are going to get served. And also, I know that CNBC is working on a big piece on this issue and the hidden homebound and access to vaccines. And I think, you know, particularly for health systems and others, you know, this is not going to go, this issue is going to keep coming up and, you know, there should be some plans and whether it's a local health department, a health system, you know, it's worth prioritizing. It's really a, when I talk to most people, you know, they get it, they understand that there are these people that need help and they're just great, you know, most people seem, I'd like to think they'd just be grateful that you have a team that's willing to do this, because this is hard. You know, the fact that you're stepping up like you are, Paul, and saying that you want to do this and you're finding a way with your team, I can't be more just in awe of your leadership and desire. And I got to think, I mean, there's a part of me that wants to drive a couple of vials from New Jersey to get out to your practice if I get a hold of them and get you going, because it's not going to be easy. I'd say one other thing we are exploring is, and again, this does take a lot of effort, but I'm keen on this idea of what I'm calling family cluster vaccination. Okay. And so this idea is the idea that we identify a homebound person who needs the vaccine. And then once we identify them, we try to figure out, are there family members, caregivers, other people who also need to be vaccinated? And we're actually working on a protocol to register them so that we could go out and not just vaccinate the homebound person, but do let's say three or four vaccinations at that home visit or five. Both of the visits, and I wasn't, it was just random how we got this, but both of the visits I went on, they were both people that were what we call completely homebound. These were not partially homebound folks. They both had two family members at minimum that would have been appropriate for vaccination. And actually I was spending a lot of time while I was doing the observation, counseling them on how to get on the community health center's website to schedule an appointment and how they might be able to. So they both had caregivers who had chronic conditions and that were older that if we had had the logistics right, we could have maybe done the family at the same time. And that would make the logistics better for this utilization of the vaccine product as well. Now it's difficult because we're not used to thinking if we have a medical practice or a home health agency, you're used to thinking that this is the person on your service. Those family members may or may not be. But that said, you're a provider and there are plenty of people who are utilizing all different providers just for vaccination. I mean, there's no relationship at the retail center between people and the people that come in and get vaccinated on a long-term basis. I don't see why some family docs and geriatricians and nurse practitioners and everybody in the home care world can't do that as well. I was just going to say, Paul, and maybe you can speak to this. I was curious if any of you have thought about, do you think you're going to have your providers, your physicians, nurse practitioners, physician's assistants be the one administering the vaccines? Or have you thought, I've received some questions because of the temporary direct supervision flexibility that can be fulfilled via telehealth with a video visit with the provider. Have you thought about using some of your other interdisciplinary team members to give these vaccines as a way to make it logistically? Although it will come with its own logistical headaches, but it could potentially save your provider time from them having to administer all of these vaccines. Absolutely. Yeah. Three quick comments I'll make. As I'm thinking about transportation, I actually wrote down the temperature. Temperature for the Pfizer is 35 to 86 degrees, for the Moderna is 35 to 77 degrees. It's snowing outside here. Well, it's not. There's snow outside here in Chicago, but as ACCI is reaching far and wide, I'm thinking there's some practices in South Florida where you have to be careful that you are exceeding the temperature of 77 degrees for Moderna. So just keep that in mind and work with your pharmacy team, which I have regarding the whole stability issue and the transportation issue. The second question, which will segue into answering your question, Brianna, is maybe I need to start a new tactic rather than shame, shame, or being a nag to the health system, but look at it maybe as a chance to celebrate as an opportunity to put a spin. That sounds terrible. To make this a positive thing. Look at the health system reaching out to the utterly disenfranchised people. Look at what Northwestern is doing. So instead of being a nag, perhaps being a point of celebration. I already thought about asking, you know, can I borrow a nurse, can I borrow MAs from other practices to help us do this? You're a big system. My God, we only have like three people at the office. Right. At Northwestern we have thousands. Well, the problem is, and Brianna knows this, even sometimes my staff is being floated to other offices because other offices are so short. They're all short staffed. So I already made my wish out there. So if we can make this into a celebration thing and not a nag thing and maybe they can float some people over to make this maybe a media thing that could be a positive thing for Northwestern. That's my wish. A lot of great conversation here. I did want to give those that are attending a chance to either unmute themselves and ask some direct questions. But we do have one question in the chat comment. Someone has put that, are you doing anything specific to navigate the CDC recommendations for supplies and equipment to have on hand in case of anaphylaxis? Having an EpiPen and oral diphenhydramine has been what I've brought on the visits that we've done. Ditto. Okay, great. Is there anyone else? I want to point out that there's been a run on the EpiPens. And so actually we've also in addition just got epinephrine vials for backup if we end up doing more of this, where, you know, we need to have epinephrine and which is not ideal, because you got to draw it up, but it would be reasonable. Anyone else there? I know we're at the half hour here and I want to be respectful of time, but I also know that this is such a valuable topic and a needed place for people to share ideas. Is there anyone out there who wants to unmute themselves or any other last minute questions? I'd like to share what they're doing as the panelists have talked about. There are different models out there. There are different staffing models, there are different types of practices and geographic differences out there. But would love to hear if anyone here wants to share and or ask any questions directly to our panelists. Feel free to unmute yourself. All right. There's a question about MAs and I would advise against that because you do need to have some clinical assessment skill to, you know, monitor for anaphylaxis. So, you know, an experienced registered nurse, I'd say yes, an MA probably not. Okay. Well, first and foremost, I want to thank you all for staying on for this extended session and joining us in this conversation, especially now when your time is more valuable than ever and spread thin. We appreciate you all. Please stay safe. We will ensure that we follow up with all of you regarding on how to get these resources that we talked about today, as well as how you can reach out to us and we can connect you with our panelists or experts as well as joining us on our HCCI COVID-19 LinkedIn group where we're going to continue this conversation and sharing of ideas. But thank you all for joining. Thank you panelists for your time and your ideas and sharing with us some of your strategies. Thank you all and have a great week. Thank you, everyone. Take care.
Video Summary
The panel discussion centered around the challenges and strategies for administering COVID-19 vaccines to homebound patients. The main challenges discussed were obtaining the vaccine supply and addressing logistical issues such as transportation and storage. The panelists shared their approaches to these challenges, including coordinating with healthcare organizations to access vaccine supply, using prefilled syringes for transportation, and implementing family cluster vaccination for efficiency. They also discussed the importance of advocating for homebound patients and ensuring their access to vaccines. The panelists emphasized the need for collaboration, proactive planning, and innovation in order to successfully administer vaccines to homebound patients. They encouraged healthcare providers to stay informed about vaccine allocation and distribution in their respective states and to actively engage with their healthcare systems and leadership to address the unique challenges of vaccinating homebound patients. The session provided valuable insights and practical strategies for healthcare providers working with homebound patients during the vaccination campaign.
Keywords
homebound patients
vaccine supply
logistical issues
transportation
storage
advocating
collaboration
vaccination campaign
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