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Last updated: 4:00PM January 11, 2021

This page is intended to be a resource for podiatrists and their staff regarding COVID-19 (coronavirus). We are committed to keeping our community of podiatry healthcare professionals abreast of the evolving pandemic and will update this page as the situation changes and will continue adding information as it comes to us. We are not responsible for the content on sites linked from this page, but we hope they will serve as additional resources to you during this challenging time. The COVID-19 situation continues to change rapidly, so while we are doing our best to keep this page accurate, all information is subject to change.

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FAQs

Telemedicine

How will I be protected if I choose to use telemedicine to minimize patient contact and presence?

In general, telehealth services can be covered under your policy. Our policy mandates appropriate state licensure and adherence to scope of practice, state and federal laws for your specialty, as well as any telemedicine laws or regulation. Additionally, we recommend the following:

  • Consider your practice and patient mix to decide what services can be provided via telemedicine technology
    • Please call us if you are performing any wound care via telemedicine, or are planning to provide telemedicine services exclusively and not as a part of an expansion of delivery of services
  • Any interaction using telemedicine technology be appropriately documented in the patient’s record
  • Use of appropriate informed consent for telemedicine services
Do you have a telemedicine consent form that I can use?

We have a sample telemedicine consent form you can download and use with those patients you are providing telemedicine services to.

 

Can I use telemedicine for new patients or should I use telemedicine only for established patients?

Both new patients and established patients can be seen via telemedicine. If you are planning on starting a new telehealth business or providing wound care, please contact us. You do not need to notify us if it's in the case of an expansion of services for existing patients (unless providing wound care).

Can I perform wound care via telemedicine?
If you are providing wound care in any way, please call your account manager to discuss.
What is the difference between telehealth and telemedicine?
Telehealth refers to a broader scope of remote healthcare services and can refer to remote non-clinical services. Telemedicine refers specifically to remote clinical services.
What does the Telehealth 1135 Waiver allow?

Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients.

Additionally, the 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. More information here.

What are my options when it comes to consent for treatment via telehealth/telemedicine?

Typically, telehealth/telemedicine programs, which meet approved standards, have a process in which to execute a telehealth/telemedicine consent. Unfortunately, with our current crisis and the exceptions being permitted, it's necessary to be flexible. Providing telehealth/telemedicine services may require both a verbal and video interaction. If either the provider or patient do not have both of those resources available, then telehealth/telemedicine services will not work. If the use of the technology is not going to work for you and your patient population, you would have to make a medical decision on if you need to see patients in the office setting or if the visit can be postponed until after your state releases you to work in your office at full capacity. Follow your state and local government guidelines for who qualifies to be seen in the office under the current mandate.

Additionally, there are limited telehealth/telemedicine types of visits that may qualify for verbal consent to take place on calls, but it is a very limited scope and may not qualify under podiatry. If both the provider and patient have a way to conduct a telehealth/telemedicine visit, here are a few ways that you could complete the telehealth/telemedicine consent:

  • Option 1: Email a copy of the consent form to the patient (download a sample form here) and aks them to print it, sign it, and either scan it and email it back or take a picture with their phone and send it back as an email attachment or via text message. Copies of the email and or text communications should be entered into the medical record. If they are unable to print it, have them reply to the email stating that they have read the consent form and agree to treatment via telehealth/telemedicine.
  • Option 2: Take a picture of the consent form, send it to the patient via text message, and ask them to reply with a confirmation that they read the consent form and agree to treatment via telehealth/telemedicine. Copies of the text communications should be entered into the medical record.
Even if option 1 or 2 were completed, you should still do a verbal consent at the beginning of the visit and document that it was completed.

Coverage and Premiums

Will COVID-19 effect my premium payments in any way?
We recognize this is a difficult time for our customers and want to do everything we can to support you. For those customers with due dates prior to June 30 who are unable to make a payment, we are suspending cancelations due to non-payment until June 30, 2020. We will continue to mail invoices as normal; this is simply a notice that your policy will not be canceled due to non-payment during the grace period. Additionally:
  • There is no need to notify us if you are unable to make a payment with a due date prior to June 30, 2020
  • There is no penalty for paying the entire premium amount due on June 30, 2020
  • Late fees will be waived through June 30, 2020
  • Depending on your payment plan, regular finance charges will apply, but no additional finance charges will be accrued (this does not apply to premium finance by third parties)
  • All scheduled automated payments will continue to auto-draft; to remove automated payments, log into our website portal and select manage payments or see Instructions for Changing or Removing Auto-Pay

Additionally, we will remain in compliance with the Departments of Insurance (DOI) for individual states which have guidance beginning before or ending after our own grace period. NOTE: Invoice mailing/automated payment plan debits already established will proceed as normal unless there is specific direction from your state’s DOI; this is simply a notice your policy will not be canceled due to non-payment during the grace period.

For all state DOI bulletins, please click here.

Can I be held responsible for canceling appointments? If a condition worsened because the office was closed during COVID-19, would this be considered patient abandonment?

The decision to treat or NOT treat a patient based upon concerns of COVID-19 spread is one of balancing the harm to the individual patient versus that of others in the office and the community at large. If a patient appointment is cancelled due to circumstances out of the control of the office, like staffing issues due to the virus, it is unlikely to create an issue – even if it is alleged that the condition worsened due to the cancellation. This most likely would not be considered abandonment.

If the office is concerned after questioning and examining a patient (taking their temperature) that the patient is showing signs of the virus or has been exposed, it is perfectly acceptable to cancel or reschedule them unless it is a true acute emergency – in that case, the physician should utilize universal precautions and limit the patient’s exposure to other patients and unnecessary staff.

Will I be covered if I perform duties outside of my scope of practice due to federal or state executive orders?

During this time of the COVID-19 pandemic, we have been asked about medical professional liability coverage related to federal and state laws and executive orders that may expand the scope of practice for our policyholders. As our policy is a scope of practice policy, policyholders’ coverage is expanded accordingly by these individual state and federal laws or executive orders and will remain in effect until these laws or executive orders are rescinded.

If I am required by state or federal authorities to temporarily close my office, is this considered patient abandonment?

Abandonment occurs when you terminate a patient relationship without giving the patient adequate notice or time to locate another practitioner. Therefore, under the unprecedented circumstances we all face right now, a mandate by a state or federal authority to temporarily close your office and limit treatment to emergency care only, is not a termination of the relationship, and there can be no “abandonment.” Moreover, you are to use clinical judgement to determine level of risk. If the patient is high risk, in acute phase of treatment, post-operative, or wounds need to be assessed regularly, you would be able to see them in the office under emergency or essential care.

What is the "APMA Position Statement: Doctors of Podiatric Medicine Ready to Serve during National Health Emergency"?
From APMA, "The United States is facing an unprecedented health-care emergency. Doctors of Podiatric Medicine (DPMs) stand ready to lend our support during this time of crisis as front-line caregivers. Our advanced training and experience are ideal for triage, support, treatment of injuries and wounds, and medical management in acute care settings such as hospitals. APMA supports podiatric physicians’ and surgeons’ voluntary contribution in this crisis to their level of education, training, experience, and expertise. APMA believes it is necessary for state and federal officials to temporarily authorize DPMs to legally practice beyond their scope of practice to provide for the needs of the public during this national health emergency."
Will you be deferring any non-renewal underwriting actions at this time?

It is our commitment to remain in compliance with Departments of Insurance (DOI) for individual states which may provide specific guidance on deferring non-renewal underwriting actions.

Will you be offering a continuation of coverage for any expiring policy?

During this time, we are renewing policies unless specifically requested by the policyholder not to. We understand many of our policyholders may not be in their office and not working, so our intent is to make the renewal processes one less headache to figure out. If you do not want to renew your policy, please contact us.

Practice Management

How can I prepare my office for COVID-19?

Here are several ways you can prepare your office for COVID-19, including (but not limited to):

  • Hold a staff meeting to educate employees on COVID-19 and what they can do to prepare.
  • Prepare to contact patients who may have been exposed in your office. Should it be later disclosed/discovered that a patient infected with COVID-19 was in your office, all patients and others who were in the office the same day should be notified.
  • During appointment confirmation calls, ask if the patient, close family members, co-workers, or the person(s) accompanying them to their appointment have any symptoms of acute respiratory illness (e.g., fever, cough, sore throat, recent difficulty breathing), or have recently traveled internationally, especially to currently identified hot zones for the infection.
    • If so, cancel the appointment, unless the patient is experiencing an acute emergency. Depending on the patient’s reported flu-like symptoms, it may be advisable to refer them to an emergency room. Strongly advise them to report their symptoms to their healthcare provider, and the local health department.
    • If not, instruct the patient that if their respiratory health changes prior to their appointment, please call to cancel and request that they contact their primary care physician for further evaluation.

           NOTE: if you handle appointment confirmations via pre-recorded messages, you should also consider updating those recordings to include                       information regarding COVID-19.

What should I do if I subsequently learn that a patient who visited my office tested positive for COVID-19?
Take extra steps to thoroughly disinfect all areas of the office the patient contacted. Notify all patients, employees, and others, if you subsequently learn that an infected patient or employee was in the office.
Will I be covered if a patient alleges that they contracted COVID-19 at my office?
  • Patient exposure at your practice: Your professional liability policy may defend and indemnify you against claims by patients who allege they contracted COVID-19 at your office depending on the nature of the allegations. Negligent acts and omissions are generally covered, while liability for intentional conduct is excluded. For example, if a patient contracts COVID-19 at an insured’s office despite an insured’s best efforts to follow current guidelines, such a claim could fall within the coverage of the policy. Alternatively, if an insured continues to treat patients after the insured knows he or a staff member is contagious with the virus, this could lead to a claim of intentional conduct, which is excluded by the policy.

    Download and use our Sample Patient Acknowledgement to Receive Treatment During COVID-19 Form.

    Note: We cannot provide a coverage opinion or confirm coverage as to hypothetical claims. Coverage opinions are provided only after analyzing the specific allegations of an actual claim together with the applicable policy. The information here is general in nature and should not be interpreted to mean any given claim or actions by an insured will be covered by our policy. Rather, we will adhere strictly to the provisions of our policy, which is the only statement of our coverage obligations.
  • Office staff exposure at your practice: In general, our policies exclude coverage for any claim made by an employee, unless the claim arises from the employee’s status as a patient of the practice.
From a legal perspective, can I be held responsible by patients or staff if someone contracts COVID-19?

In regard to patients:

Physicians ALWAYS have a duty to utilize "universal precautions" notwithstanding the current crisis. Universal precautions, standard precautions, and contact precautions should ALWAYS be utilized with all patients – those are the standards to prevent cross contamination. To the extent a physician is not following current generally accepted guidelines, they may be held liable to a patient or staff member.

Office should already have policies in place to aid in prevention of all respiratory diseases, but if not, the office should immediately put into effect strict respiratory hygiene/cough etiquette guidelines.

More on the CDC website:

In regard to staff:

OSHA’s General Duty Clause, Section 5(a)(1) of the Act, requires an employer to protect its employees against “recognized hazards” to safety or health which may cause serious injury or death. While there is no specific regulation dealing with COVID-19, it is the General Duty Clause which mandates that you must act to protect your employees.

You are obligated under OSHA to develop a written plan to protect your employees from this risk. The plan assessing the “hazard” should include, but is not limited to:

  • Training employees with regard to the hazard
  • Revisiting the procedures utilized with personal protective equipment (PPE)
  • Recording (logging) any illness which are occupationally related
  • Documenting all efforts and training on this hazard

More information from OSHA:

Does PICA have an opinion on podiatrist and patient contact or keeping the office open?
This depends on what your specific state is requiring. The CDC is not providing a specific definition to essential services. General routine foot care is not an essential service, but treatment of acute conditions or post-surgical care could fall under essential services. The practice needs to consider if the employees, including the DPM, are in a healthcare class who should not be providing services or not. Many younger, healthy providers have determined they will stay open and screen all patients (and those accompanying the patient) before their appointment and upon arrival by checking for signs/symptoms of COVID-19, and asking if they have traveled out of the country or been exposed to an individual with the virus.

Ultimately, it is the practice's responsibility to determine what patients may fall into an acute healthcare situation and those who would not. The practice can close the office if they feel their patients are not in need of immediate ongoing treatment that might be detrimental to the patient’s recovery. If they determine that they are closing, they need to contact the patients on the schedule and reschedule the appointments. However, the patients under acute conditions or post-surgical care, who could suffer from not being seen, either can be evaluated on a one-on-one basis and be seen, or instructed to go to an urgent care or hospital if the condition needs immediate evaluation and treatment.

If you are seeing patients in the office, increase time for each appointment, segregate individuals in the waiting room, clean the treatment room with proper healthcare grade virucide in between each patient seen, provide proper PPE for all staff, have the patients return to their vehicle and call them in when ready to see them, and discourage minors from accompanying the patient.
What constitutes urgent care or a podiatric emergency that would be deemed appropriate to treat in the podiatry office during this COVID-19 restricted time?

Federal and state authorities have asked that physicians limit care to emergency and/or urgent care, so here are examples of these situations. As always, use your best judgment based upon each individual patient’s symptoms, their treatment record, and history to determine if emergency or urgent care is warranted.

Examples of emergency situations:

  • Trauma
  • A severe infection such as a cellulitis, or other diffuse soft tissue swelling
  • Uncontrolled bleeding

Examples of urgent care situations:

  • Severe and intractable pain
  • Localized abscess
  • Suture removal

Additionally, if you decided to close your practice while having patients under active management (such as post-ops less than four weeks out, patients under acute care management, or active acute wound care), you must appropriately refer patients to another provider to continue their care. Failure to do so could create a situation of patient abandonment.

Should I ask my employees to sign a release to work or question if they want to work?

Having an employee sign a release likely would not make a difference or stand up in court. For further guidance, reach out to your workers' compensation or employee practice carriers to see if they have any advice. Most importantly, make sure you are following state and local guidelines.

If an employee were to request not to work at the office interacting with patients and the public during this COVID-19 crisis, it is likely that you would need to honor that request. If the employee chooses to work, and you provide the training, proper PPE, screen patients, and function under universal precautions, you would have done what was necessary. However, some employees may need more reassurance than others. Ultimately, even if you do everything perfectly, there is always a chance they still might catch the virus.

Can I take an employee’s temperature at work to determine whether they might be infected?
Yes. The EEOC confirmed that measuring employees’ body temperatures is permissible given the current circumstances. While the Americans with Disabilities Act (ADA) places restrictions on the inquiries that an employer can make into an employee’s medical status, and the EEOC considers taking an employee’s temperature to be a “medical examination” under the ADA. The federal agency recognizes the need for this action now because the CDC and state/local health authorities have acknowledged community spread of COVID-19 and issued attendant precautions. However, as a practical matter, an employee may be infected with COVID-19 without exhibiting recognized symptoms such as a fever, so temperature checks may not be the most effective method for protecting your workforce. Note: If your company does business in the State of California (e.g., if you have one or more locations, employees, customers, suppliers, etc. in the state), and your business is subject to the California Consumer Privacy Act (CCPA), then you must provide employees a CCPA-compliant notice prior to or at the same time as your collection of this information. For advice on CCPA compliance, please reach out to any member of our Data Security and Workplace Privacy Practice Group at any of California offices.
An employee of ours has tested positive for COVID-19 - what should we do?

For guidance on how to handle, contact your local public health department. If those resources are not available, recommendations are that you send home all employees who worked closely with that employee to prevent spreading. Before the infected employee departs, ask them to identify all individuals who worked in close proximity (within six feet) for a prolonged period of time (more than a few minutes) with them in the previous 14 days to ensure you have a full list of those who should be sent home. When sending the employees home, DO NOT identify by name the infected employee or you could risk a violation of confidentiality laws. If you work in a shared office building or area, you should inform building management so they can take whatever precautions they deem necessary. The CDC provides that the employees who worked closely to the infected worker “should then self-monitor for symptoms (i.e., fever, cough, or shortness of breath).”

How long should the employees who worked near the infected employee stay at home?

Those employees should first consult and follow the advice of their healthcare providers or public health department regarding the length of time to stay at home. If those resources are not available, the employee should at least remain at home for three days without a fever (achieved without medication) if they don’t develop any other symptoms. If they develop symptoms, they should remain home for at least seven days from the initial onset of the symptoms, and three days without a fever (achieved without medication). DO NOT identify by name the infected employee or you could risk a violation of confidentiality laws.

One of our employees self-reported that they came into contact with someone who had a presumptive positive case of COVID-19 - what should we do?

Treat the situation as if the suspected case is a confirmed case for purposes of sending home potentially infected employees. Communicate with your affected workers to let them know that the employee is asymptomatic for the virus but you are acting out of an abundance of caution. Those employees should first consult and follow the advice of their healthcare providers or public health department regarding the length of time to stay at home. If those resources are not available, the employee should at least remain at home for three days without a fever (achieved without medication) if they don’t develop any other symptoms. If they develop symptoms, they should remain home for at least seven days from the initial onset of the symptoms, and three days without a fever (achieved without medication). DO NOT identify by name the infected employee or you could risk a violation of confidentiality laws.

Can we require an employee to notify the office/company if they have been exposed, have symptoms, and/or have tested positive for COVID-19?

Yes, you should require any employee who becomes ill at work with COVID-19 symptoms to notify their supervisor. Employees who are suffering from symptoms should be directed to remain at home until they are symptom-free for at least 24 hours. While outside of work, if an employee begins experiencing symptoms, has been exposed to someone that is exhibiting symptoms, or has tested positive, the employee should contact your office/company by telephone or email and should not report to work.

Can an employee refuse to come to work because of fear of infection?

Employees are only entitled to refuse to work if they believe they are in imminent danger. Section 13(a) of the Occupational Safety and Health Act (OSHA) defines “imminent danger” to include “any conditions or practices in any place of employment which are such that a danger exists which can reasonably be expected to cause death or serious physical harm immediately or before the imminence of such danger can be eliminated through the enforcement procedures otherwise provided by this Act.” OSHA discusses imminent danger as where there is “threat of death or serious physical harm,” or “a reasonable expectation that toxic substances or other health hazards are present, and exposure to them will shorten life or cause substantial reduction in physical or mental efficiency.”

When may an employee discontinue home isolation?

Per the CDC, there are three options for determining when a person may end home isolation, using either 1) a time-since-illness-onset option, 2) a time-since-recovery option, or 3) a test-based option. More information here. 

Is COVID-19 a recordable illness for purposes of OSHA logs?

COVID-19 can be a recordable illness if a worker is infected as a result of performing their work-related duties. More information here. 

Legal Notice and Disclaimer: Please note that the information contained in these resources does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only and is written from a risk management perspective to aid in reducing professional liability exposure. Please review these documents for applicability to your specific practice. You are encouraged to consult with your personal attorney for legal advice, as specific legal requirements may vary from state to state.

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