Considerations for discharging patients from hospitals and SNFs

Discharging patients that have had a known or suspected COVID-19 infection has become a crucial undertaking for hospitals straining for resources during this crisis. This episode will provide guidelines for patient discharge, including symptoms to look for, testing procedures, precautions and patient mental acuity.
 
Guest speaker:Aman Sabharwal, MD, MHA, CPHMSenior Principal, Operational EffectivenessAdvisory SolutionsVizient
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMAssociate Vice PresidentClinical ResourcesVizient
 
Show Notes:
[01:12] CDC and AHA guidelines on discharges
[01:47] Test-based approaches
[03:21] Non-test-based strategies
[05:25] Transmission-based precautions
[07:20] Discharge planning
[09:19] CMS waivers for transfers
[11:45] When a patient no longer requires transmission-based precautions
[12:30] Cooperation to deal with surges
[13:15] Three-midnight rule and the 30-day discharge waiver
 
Links | Resources:
Vizient COVID-19 Resource Page: Click here
CDC Guidelines on Discharging Hospitalized Patients: Click here
Post-Acute Care for Vulnerable Populations with COVID-19: Click here
Hospitals: CMS Flexibilities to Fight COVID-19: Click here
Accepting Admissions from Hospitals during COVID-19 Pandemic: Click here
Patients from Nursing Homes Are Stuck in Hospitals After Contracting COVID-19: Click here
 
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Expanded waivers and their impact on increasing scope of practice

COVID-19 has shattered restrictions on Advanced Practice Providers (APPs), resulting in expanded scope of practice in states across the country. On this episode, two leading experts return with an update on the sweeping changes occurring in just the last couple of weeks, including expanded waivers and increasing scope of practice.
 
Guest speakers:Christen Hunt, DNP, NP-C, CPNP-ACDirector, Nursing Programs/CAP2™ Vizient
Susan Cymbor, MDPhysician Accreditation AdvisorVizient
 
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMAssociate Vice PresidentClinical ResourcesVizient
 
Show Notes:
[01:30] Changes to expanding the scope of practice
[03:56] Changes with processes regarding locum tenens
[04:43] What organizations can do in changing scope of practice
[06:25] New waivers and effect on MIPS reporting and telehealth
[08:07] How long will these scope-of-practice changes be in effect?
[09:42] New flexibility regarding beds and patient placement
[11:02] Waivers regarding patient discharge
[12:25] Two types of waivers
[13:06] Challenge of getting out of emergency operation plans in future
 
Links | Resources
Vizient’s disaster preparedness page: Click here
AANP: COVID-19 State Emergency Response: Temporarily Suspended and Waived Practice Agreement: Click here
CMS Waives Certain Requirements to Expand Healthcare Workforce, Put Patients over Paperwork: Click here
Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge: Click here
 
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Forecasting the operational and financial impacts of COVID-19

The COVID-19 crisis has disrupted the financial and operational aspects of care delivery. Looking ahead, health care organizations will face even more changes.
Join Dr. Tom Villanueva as he leads a discussion with two leading experts on strategies to prepare for the next stages of the crisis and even for the aftermath. They will look at maximizing capacity, the impact of payer mix operationally, patient issues and restarting the business side of care.
 
Guest speakers:
Brian Esser, MBA
Associate Principal
Intelligence
Vizient
 
Ryota Terada
Director
Intelligence Sg2
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes:
[01:42] Financial impact health care organizations are experiencing
[02:49] Getting back to normal
[05:13] Patient attitudes/preferences as a factor in capacity
[05:53] Need for discussions among hospital leaders before restoring capacity
[08:32] Areas for testing before procedures undertaken
[09:47] Payer mix
[11:46] Communicating that safe care is available; building trust
[13:18] Virtual care
[16:00] Role/re-emergence of the independent practitioner
 
Links | Resources
Vizient COVID-19 Resource Page: Click here
University of Wisconsin: Financial and Operational Impacts: Click here
The COVID-19 impact on the revenue cycle for hospitals and other healthcare providers: Click here
 
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Accessing federal funds through the CARES Act

To support providers during the COVID-19 crisis, Congress has passed the Coronavirus Aid, Relief and Economic Security (CARES) Act, a $2 trillion stimulus package designed to provide funds for health care organizations across the country.
Join Dr. Tom Villanueva as he discusses this law with a colleague from Sg2, who will describe how organizations can access the funds provided through the CARES Act.
 
Guest speaker:
James Reilly
Senior Principal
Sg2 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes:
[01:10] What the federal government has made available to health care organizations
[05:34] Accessing funds
[07:39] Eligibility for funding
[09:23] Special considerations for public hospitals
[11:00] Considerations for severe-outbreak areas
[11:49] Expenses covered and not covered
 
Links | Resources
Sg2 crisis page: Click here
Fact Sheet: Accelerated and Advanced Payment Program: Click here
A Look at the $100 Billion for Hospitals in the CARES Act: Click here
CARES Act: Provisions to Help Rural Hospitals: Click here
CARES Act fund to reimburse providers for uninsured patients: Click here
 
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Understanding the CARES Act

Health care organizations are feeling the huge impact of COVID-19 on a number of fronts. In particular, the impact on the financial front has been onerous and extensive. In response, Congress has passed the Coronavirus Aid, Relief and Economic Security (CARES) Act, the largest stimulus bill in history with various loan and grant opportunities to support hospitals.
On this episode, an expert will provide an update on leading provisions of the CARES Act and what this act can do for health care organizations during this crisis.
 
Guest speaker:
Shoshana Krilow, JD
Vice President
Public Policy and Government Relations
Vizient
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes:
[02:00] Explanation of the CARES Act
[03:13] Clinicians included in package
[03:45] Support for health care organizations
[06:55] Immediate goal: to start distribution to providers
[07:40] Start of distribution based on Medicare FFS claims
[09:50] Loans available
[11:00] Medicare Accelerated and Advanced Payments Program
[11:33] Provider relief fund coverage
[16:05] Advocating for assistance
[17:31] Additional package
[18:00] Additional benefits, changes and ramifications of CARES Act
 
Links | Resources
Summary of CARES Act: Click here
Fact Sheet: Accelerated and Advanced Payment Program: Click here
Responding to COVID-19: Using the CARES Act’s Hospital Fund to Help the Uninsured, Achieve Other Goals (Health Affairs): Click here
CARES Act Provider Relief Fund (HHS): Click here
 
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Enhancing appropriate hospital flow during a crisis: Telemedicine

Telemedicine, or virtual health, has been an underused approach to patient care, despite a clearly stated patient preference for it. The reasons for this have been numerous and varied, but in this time of crisis, telemedicine is emerging as a way to fulfill the current need for social distancing while providing appropriate, continued care.
Join Dr. Tom Villanueva as he discusses telemedicine with a leading expert in the field of virtual health. They’ll cover how the COVID-19 crisis has prompted greater efforts in this field to provide the care patients need.
 
Guest speaker:Chris Pagano, MBASenior DirectorVirtual HealthSg2
Moderator:Tomas Villanueva, DO, MBA, FACPE, SFHMAssociate Vice PresidentClinical ResourcesVizient
 
Show Notes:
[01:49] Acceleration at an unprecedented rate
[02:11] Fighting COVID-19
[02:35] Key policy changes affecting virtual health
[05:24] Areas of focus for health care organizations
[09:57] Challenges for virtual health
[13:20] The new normal
 
Links | Resources
COVID-19 – Using 21st century tools to triage, test and treat (Providence Telehealth): Click here
Coronavirus COVID-19: Telehealth and Virtual Care: Click here
Sg2 crisis page: Click here
COVID-19 will accelerate the age of virtual medicine: Click here
List of payable telehealth services: Click here
Mobile Health and Telemedicine (JAMA page with ongoing updates on telemedicine): Click here
 
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Enhancing appropriate hospital flow during a crisis: ED surge plans

During the COVID-19 crisis, emergency departments are having to grapple with disruptions in patient flow and with shortages and other challenges that are only expected to increase as coronavirus cases surge.
On this episode of Modern Practice, a leading expert in emergency department throughput discusses with Dr. Tom Villanueva how health care organizations can address the new demands they face in this crisis.
 
Guest speaker:
Martin Lucenti, MD, PhD
Senior Vice President and Chief Medical Officer
Solution Architecture
Vizient
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Show Notes:
[01:19] Effect of the COVID-19 crisis on EDs
[01:40] Reduction in ER visits
[02:54] Preparing for the surge—disaster management
[05:42] Examples: New York and Washington
[07:56] ER throughput
[08:41] Example of combat hospital
[09:39] Yale and PPE
[11:33] Providence’s Clinical Disaster Planning Framework
[17:10] Cross-training
[19:06] Regulatory issues
[20:33] Telehealth and the ER
 
Links | Resources
Clinical Disaster Planning Framework: Click here
Yale New Haven Health PPE Strategy: Click here
University Health System: Emergency teams prepare for a surge in patients: Click here
CDC: Steps Healthcare Facilities Can Take: Click here
COVID updates—American College of Emergency Physicians: Click here
 
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Modeling surge demand for COVID-19

Of the many challenges spawned by COVID-19, the demand on resources has hit health care organizations the hardest, obliterating their staffing models as cases have surged. Predicting that demand is of paramount importance. On this episode, two experts from Sg2 describe the features and capabilities of a new modeling approach that can revolutionize how health care organizations plan for surge capacity during this coronavirus crisis.
 
Guest speakers:
Madeline McDowell, MD, FAAP
Practicing pediatrician
Principal and Medical Director
Quality and Strategy
Sg2
 
Meghan Robb
Vice President, Product Management
Sg2
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Links | Resources
To download the Surge Demand Calculator: Click here
Sg2 crisis page: Click here
CDC surge planning page: Click here
Cleveland COVID-19 surge plan creates 10,000 new beds: Click here
Emergency department strategic planning: Click here
 
Show Notes:
[01:32] The necessity of predictive models during the COVID-19 surge
[03:46] Features of the SG2 Surge Demand Calculator
[06:10] Insights gained
[11:03] Methodology
[13:37] Rates used in the model
[15:26] Inputs
[17:33] Outputs
[18:30] Feedback on the calculator
[20:00] Acquiring the tool (free of charge)
 
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Expanding scope of practice for the COVID-19 surge

COVID-19 cases have exploded, disrupting hospital staffing plans and stretching resources well beyond even emergency levels. With cases only expected to surge further, health care organizations need to find innovative ways to increase their staffing levels to meet the care needs of this crisis.
On this episode of Modern Practice, two leading experts in this field discuss with Dr. Tom Villanueva how expanding scope of practice for Advanced Practice Providers is proving to be an answer to staffing challenges.
 
Guest speakers:
Christen Hunt, DNP, NP-C, CPNP-AC
Director, Nursing Programs/CAP2™
Vizient
 
Susan Cymbor, MD
Physician Accreditation Advisor
Vizient
 
Moderator:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Links | Resources
COVID-19 nurse practitioner policy and practice updates: Click here
APP licensure information state-by-state: Click here
CAP2™ website: Click here
Federal and state efforts to expand clinical workforce during COVID-19: Click here
Texas governor waiving regulations to expand health care workforce: Click here
Christen Hunt’s LinkedIn page: Click here
 
 
Show Notes:
[01:58] What the coronavirus is doing to hospital staffing levels
[03:03] Expanding scope of practice to alleviate these staffing challenges
[04:55] Crisis staffing
[06:36] Current efforts
[10:33] Permanence of changes to scope of practice
 
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University of Utah's and University of Wisconsin's COVID-19 experience

Emerging strategies from the University of Utah and University of Wisconsin to combat COVID-19
 
On this episode of Modern Practice, we’ll hear from experts at two leading medical centers who discuss the use of investigational medications to treat patients infected with COVID-19, including the drugs chloroquine, hydroxychloroquine, remdesivir and others.
 
Guest speakers:
Emily Spivak, MD, MHS
Associate Professor of Medicine
Medical Director
Antimicrobial Stewardship Program
University of Utah Health
 
Lucas Schulz, PharmD, BCIDP
Clinical Coordinator
Infectious Diseases
UW Health
 
Moderators:
Tomas Villanueva, DO, MBA, FACPE, SFHM
Associate Vice President
Clinical Resources
Vizient
 
Lindsay Mayer, MSN Senior Director
Programs, PI Collaboratives
Vizient
 
Show Notes:
[01:10] Overview of investigational agents
[01:50] Chloroquine/hydroxychloroquine
[05:10] Adding azithromycin to the treatment
[06:43] Pros and cons for chloroquine/hydroxychloroquine
[09:22] Lopinavir/ritonavir
[10:25] Remdesivir
[14:00] COVID-19 treatment guideline
[15:40] Further comments on azithromycin
[17:54] Supportive care is the only recommended care
 
For additional information on COVID-19 and how Vizient is supporting our members, visit vizientinc.com