Summit Medicine and Pediatrics (SMP) is dedicated to providing at all times within our office a safe and healthy environment for our patients and our staff. While efforts to define and to contain the COVID-19 pandemic continue to evolve, SMP is taking proactive, thorough and voluntary steps to prevent the spread of the disease in our office and in our community.
What is Summit Medicine and Pediatrics Doing for You in Planning for and Addressing the COVID-19 Pandemic?
- Daily Thorough and Repetitive Cleaning
According to the Center for Disease Control and Prevention (CDC) and the World Health Organization (WHO), the disinfection of flat surfaces is a key component in a comprehensive strategy to minimize the spread of both viral and bacterial illness. Using bactericidal and viricidal products approved by the Environmental Protection Agency (EPA) and Occupational Safety and Health Administration (OSHA), SMP is working constantly to ensure a healthy and reassuring experience:
- Facilities – Our facility adheres to strict infection control and public health safety policies and recommendations in accordance with both CDC and OSHA guidelines. SMP has augmented its regular infection control cleaning program, including cleaning for high traffic areas, door handles, chair arms, computer keyboards, telephones, toilets, and other frequently touched surfaces.
- Reception – SMP does not have a crowded ‘Waiting Room’. Rather, our patients sit comfortably in a reception area that allows ‘Social Distancing’ and they are escorted promptly to be seen by our medical staff in a timely and efficient manner. Upon arrival at our facility, patients who express concerns for, or exhibit signs of, infectious disease are brought back immediately to our treatment areas.
- Treatment Areas – SMP has augmented the cleaning schedule of all treatment areas, including the cleaning of certain, high-traffic, frequent-touch surfaces in between patient visits. We make disinfectant supplies readily available to our staff for spot cleaning at every level of care.
- Isolation – For patients who arrive with complaints consistent with COVID-19 or Influenza, SMP has a dedicated ‘Isolation Room’ into which such patients are invited immediately for evaluation and treatment upon arrival at our facility. Our Isolation Room is cleaned thoroughly and promptly after each use.
- Access to Hand Sanitizer, Hand Soap, Disinfectant Spray, Disposable Drinking Cups, and Disposable Facial Tissues; Mobile Phone Use Restriction; Automatic Payment Authorization
The principles of personal hand hygiene, including avoidance of touching one’s eyes, nose and mouth, is an essential component to minimizing the spread of COVID-19 and other viri. Our staff is required to apply such principles throughout the day, and we remind our patients constantly to do so while visiting us at our facility. While we know many patients are following these principles, here are some other ways SMP assists patients with methods to reduce the transmission of illness:
- Hand Sanitizers – SMP has hand sanitizer dispensers at reception and treatment areas for use by both staff and patients.
- Hand Soap – At every turn, between patient appointments, and as often as twice and hour, our staff washes their hands thoroughly with warm, soapy water for a minimum of 20 seconds.
- Disinfectant Spray – Many viri are aerosolized for minutes prior to landing and remaining viable for days upon flat surfaces. SMP staff applies disinfectant spray frequently to reduce such risk for viral transmission, both through aerosolized inhalation and by surface contact.
- Disposable Drinking Cups – We have retired (temporarily) our glass and ceramic coffee cups, and now offer complimentary water and other hot and cold beverages to our patients in disposable drinking cups.
- Disposable Facial Tissues – ‘Sneezes and Coughs’ are a major cause for the transmission of viri. We provide, throughout our facility, boxes of disposable facial tissues. We adhere to the ‘one cough, one tissue’ principle, and throw away used tissues immediately.
- Mobile Telephone Use Restriction – Mobile telephone carry many viri and bacteria. We encourage our staff and patients alike to avoid handling and using their mobile telephones at all times within our facility.
- Automatic Payment Authorization – Currency and credit cards carry many viri and bacteria. Payment for services at SMP is authorized and processed without our patients having to access or handle their cash and credit cards.
- Specialized Testing for COVID-19
Effective 16 March 2020, SMP is partnering with Sonora Quest Laboratories to provide testing for COVID-19 infection. We will begin offering COVID-19 testing to those who meet the Center for Disease Control (CDC) clinical and/or epidemiological criteria for COVID-19 testing: CDC Information for Healthcare Professionals
COVID-19 testing will be restricted to the following persons:
- Established patients exclusively
- Established patients who are symptomatic with fever, cough or shortness of breath
- Established patients who have been exposed to others with fever, cough or shortness of breath (possible COVID-19 infection)
- Established patients who have been exposed to others confirmed to have been infected with COVID-19
Established patients who would like to be tested for COVID-19 are invited to contact our office at 480-981-9000 to schedule an appointment. At all times at Summit Medicine and Pediatrics, we are cognizant of the importance of reducing the risk of the spread of infectious disease among our patients. Therefore, it is important to note that WALK-IN TESTING AT OUR OFFICE IS NOT PERMISSIBLE; in the interest of maintaining strict control and reduced risk of infectious outbreak, we plan to cluster our patients into specific time slots for COVID-19 testing, and encourage all patients who are symptomatic with fever and cough to arrive at our office wearing their own protective N-95 mask upon arrival, and apply the following procedure:
- PARK AND REMAIN IN YOUR VEHICLE upon arrival at our office at the time of your appointment
- Call our office at 480-981-9000 and notify our staff of your arrival and location within the parking lot
- Dr. Mike will approach your vehicle in full, droplet isolation attire and obtain the testing specimen as you remain in your vehicle
- You will receive and review instructional and educational material regarding the testing process and Dr. Mike will answer any questions you may have
- You may be required to acknowledge and sign certain documents related to the processing and billing for the testing process
Testing for COVID-19 is performed by obtaining a nasopharygeal viral swab specimen. A thin, sterile swab is inserted deeply and briefly into the naris and removed. The specimen is then sent to the lab for real-time reverse transcriptase polymerase chain reaction (RT RT-PCR). The results are typically available for review by Dr. Mike within 3-5 days, depending upon the overall test demand within the community, and results and Dr. Mike’s recommended course of action, if necessary, will then be communicated directly to the patient.
Testing for COVID-19 will be billed to our established patients’ insurance company on file, and patients are responsible for payment to Sonora Quest Laboratories for any costs attributable to copays, deductibles, restrictions in coverage, and denials of coverage. For established patients who are uninsured or under-insured, Summit Medicine and Pediatrics has negotiated with Sonora Quest Laboratories to establish a client bill fee of $110.00 for COVID-19 testing, payable at the time of service.
- Empowering Our Staff with Facts and Supplies
SMP staff are the foundation of our success, and therefore, their health, safety, skill and knowledge are paramount. Here are some ways we’re supporting our staff so they can better support our patients:
- Supplies – SMP stocks and provides hand sanitizer, hand soap, disinfectant spray, gloves, gowns, splash guards, respiratory masks, and other personal protection equipment. We also provide disposable protective facial masks for use by patients who exhibit signs of infectious disease.
- Information – SMP is continuously communicating with staff about evolving CDC and WHO guidelines and recommendations. We update our Infection Control Policies and Procedures as necessary to incorporate and apply the latest, most effective principles of infection control.
- Clothing Change – We encourage both patients and staff to change and launder clothing immediately upon returning home from our facility.
- Temporary Telemedicine ServicesOn 17 March 2020, The Center for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. The policy changes in their 1135 Waiver in the midst of the COVID-19 pandemic build upon the regulatory flexibilities granted under the federal emergency declaration: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
Key Takeaways from CMS:
- Effective for services starting 06 March 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.
- These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
- Starting 06 March 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings.
- While they must generally travel to or be located in certain types of originating sites such as a physician’s office, skilled nursing facility or hospital for the visit, effective for services starting 06 March 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.
- The Medicare coinsurance and deductible would generally apply to these services. However, the Health and Human Services (HHS) Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
- To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.
Furthermore, CMS has relaxed requirements for HIPAA compliance on platforms for telehealth services:
“What makes this latest development even more expansive is that CMS also waived enforcement of HIPAA health privacy law violations against providers acting in good faith. This means that everyday communication tools such as FaceTime and Skype, which previously couldn’t be used because they weren’t technically HIPAA-compliant, can now be used for doctors to evaluate patients. It remains to be seen how existing health systems and providers may use these technologies. Privacy remains a paramount concern, and while doctors may not wish patients to be texting them photos and questions on their personal phones, it is now a legitimate option.”
Effective 01 April 2020, SMP will offer the option to patients of visiting, in person, our office for appointments, or visiting, remotely and virtually through video connection, with Dr. Mike. It is important to note that the use of telemedicine services requires the purchase and implementation of sophisticated and HIPAA-compliant software, and due to the high demand for such services in the current healthcare crisis, it may be months before we are able to implement telemedicine services at our office. The staff at SMP will now offer to every patient the option of a standard, in person office visit, or a telemedicine, virtual office visit (when available):
- Standard Office Visit – In the office, we are able to assess vital signs, perform an examination, perform many tests (e.g. ECG), and draw blood for laboratory analysis. These aspects of an evaluation cannot be performed during a telemedicine, virtual office visit.
- Telemedicine Office Visit – Outside of the office, we are unable to assess vital signs, perform an examination, perform many tests (e.g. ECG), and draw blood for laboratory analysis. These aspects of an evaluation may limit Dr. Mike’s ability to diagnose and treat underlying medical conditions.
SMP patients who wish to take advantage of telemedicine services will be required to acknowledge and/or sign a consent specific for the telemedicine services. Once read, signed and returned to our office, we may schedule telemedicine visits at your convenience. The SMP Telemedicine Consent Form may be downloaded here:
- We are Available to You 24-Hours-a-Day, 7-Days-a-Week to respond to your Questions and Concerns
Dr. Mike is available 24/7 by dedicated mobile telephone to every one of our patients, and is ready to answer your questions and concerns. He remains in close contact with the CDC and the Arizona Department of Health for updates and information on the COVID-19 pandemic, and is more than happy and prepared to receive your calls to answer your questions, provide professional advice for staying healthy, and alleviate concern.
ANNOUNCEMENT 26 March 2020: Temporary Reduced Staffing
In the interest of reducing risk of exposure to COVID-19 to staff and patients alike, effective 30 March 2020, Summit Medicine and Pediatrics will reduce its staff by 50% through paid furlough. This policy will remain in effect through 30 April 2020, and possibly through 31 May 2020, depending upon the progress of the COVID-19 pandemic in Maricopa County. We are confident that this temporary reduced staffing will not affected adversely our commitment and ability to fulfill our responsibility to patient care.
What can You Do for Summit Medicine and Pediatrics in Planning for and Addressing the COVID-19 Pandemic?
We request that you help us keep the Summit Medicine and Pediatrics facility a healthy environment by following the CDC’s infection control recommendations for management of patients suspected of having COVID-19 infection:
- Know the Symptoms – Symptoms of COVID-19 infection may appear 2-14 days after exposure, and may include:
- Fever (greater than 100.4)
- Cough (dry, hacking)
- Shortness of breath (with routine activity, walking from room-to-room)
- Know the Alternatives – Symptoms of COVID-19 infection are similar to those of Influenza; if you’ve not yet received (and do not have a contraindication for) the annual flu shot, please consider getting one from your local pharmacy
- Call Ahead – Please call us at 480-981-9000 well-ahead of your appointment when you are sick or exhibiting early symptoms of COVID-19 illness, so that we may prepare appropriately for your visit and protect other patients from potential exposure.
- Be Prepared – Upon your entry into our facility, you will be welcomed, and:
- We will request to take your temperature immediately
- We will request that guests who accompany you into our facility and are not scheduled to be seen by our medical staff wait outside our facility or in your vehicle for the duration of your visit with us
- We will offer you the option to wait outside our facility or in your vehicle as well as we prepare for your visit with us; we will call your cell phone when we are ready for you
- Take Precautions – Consider adhering to the following principles:
- Apply ‘Social Distancing’ by avoiding close contact with others in your household and community; always keep a distance of 5 feet from others
- Avoid hugs, kisses, handshakes, ‘high-fives’, and other skin-to-skin contact when greeting others
- Cover your coughs or sneezes with a facial tissue, then dispose of the used facial tissue immediately in the trash
- Clean and disinfect frequently objects and surfaces that are touched frequently, such as doorknobs, door handles, chair arms, computer keyboards, telephones and toilets
- Use hand sanitizer when entering and exiting supermarkets, department stores, convenience stores, and offices, including Summit Medicine and Pediatrics
- Wash your hands frequently with warm, soapy water for at least 20 seconds before eating, after using the bathroom, and after blowing your nose, coughing or sneezing
- Be prepared and informed on updates for the COVID-19 pandemic by visiting the CDC website at www.cdc.gov/
Let’s Remember at All Times What We’ve Learned from Other Global Pandemics.
COVID-19 isn’t the first pandemic we’ve faced. We have learned a great deal from pandemics associated with SARS, MERS, H1N1 and Ebola, and such experience has helped prepare us to take care of COVID-19 patients today. While every major health event in our communities has unique elements of concern and unknowns to discover, we are uniquely positioned to provide exceptional care to our COVID-19 patients. We will get through this… together.
Here are some helpful sources for information on the COVID-19 pandemic:
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