SROA COVID-19 Radiation Oncology Q&A

By Mel Kauffman

SROA recently hosted a COVID-19 Q&A webinar session with four Board members. The members discussed what their facilities are doing to manage the CDC guidelines and the changing dynamic of the COVID-19 pandemic. All questions asked during the webinar were from SROA members.

Jana Grienke – SROA Chair - University of Iowa

Debra Corbin – President-Elect - Northside Hospital Cancer Institute

Sharda Kohli – Secretary/Treasurer – Rutgers Cancer Institute of New Jersey

Maria Grice – Member-at-Large – Hematology Oncology Associates of CNY

Q. Are any of you requiring your employees to take paid time off or PTO when there is no option for work from home for them?

A. Maria Grice: We have implemented what we call A & B teams with staff that can work from home. Our advanced practice staff went to 50% in the office and 50% at home. We have not done that with our physicians. We have allowed our team to take time off that was not accrued. For people who do not want to work, we are allowing people to take a leave of absence, or they are being asked to take paid time off or PTO.

Jana Grienke: We are kind of doing a similar thing with the two different teams, essential vs. the non-essential. Knowing that one side primarily will always be at work and looking at the other team, see what options for work at home. We have not required anyone to take time off. However, we are allowing people to work from home if they can, and those who can't, if we can do some kind of rotation we are allowing them to take turns like taking vacation time for now.

Sharda Kohli: Everyone at the University side has moved to remote operations. Clinical In terms of our clinic operations, the health system has been discussing scenarios for furloughing employees for periods. Currently, the front desk is working on rotations.

Debra Corbin: So, we have not mandated that staff take PTO time yet, but we are evaluating our productivity model to decide how much staffing we need to have. We have looked at A & B teams; we also are looking at a 2-week rotation where staff can take leave and use PTO to be off for one week.

Q. What level of cooperation are you receiving from insurance companies re. Reimbursements for telemedicine visits?

A. Maria Grice: We rolled out telehealth recently, on a fast-track, and have seen success. Excellis is the largest insurance company that is used, and they are paying all telemedicine visits and drive-thru lab services. We've got a lot of success locally with our private payers. Medicare has also relaxed a lot of the rules to allow people to use telehealth and drive-thru services.

Q. If you don't already have approved technology in place, are you having any trouble implementing the necessary state of emergency technology for the televisits, or Skype, or any other services? Or did you all have those, to begin with?

A. Jana Grienke: One of the things that they did, which I thought was interesting, is they're allowing for these little pods, so the physicians can go to these different places in the hospital that they have set up to do the video visits specifically. It's having to be done incrementally just because not all areas have the capability of the equipment to do the video visits.

Debra Corbin: We are making sure that the physician's documentation is the same, that we're still requiring them to log in documenting our EMR because a lot of people are under the misconception that you can have a phone call and it's a Telehealth, and that is not. We've set it up that there are two orders. One is a virtual phone check-in, which is a different code for an AP or MD to make. Then we have the telemedicine audio-video activity, and it's attached to a different code as well.

Q. Are you allowing patients to bring a visitor or companion to the appointments for treatments or consult, or are you limiting that right now?

A. Jana Grienke: We had started limiting to two visitors per patient. They had to be adults, no one under the age of 18. If it was a pediatric patient, they could have two healthy parents. That quickly was reduced to one visitor per patient but still left at the two healthy parents for a pediatric patient.

Sharda Kohli: At Rutgers, we're limiting to one visitor per patient.

Maria Grice: We first started with limiting to one visitor but changed and are not allowing ant visitors with patients. There are rare exceptions.

Debra Corbin: We're not allowing visitors unless they need help from a family member.

Q. What personal protection equipment are you requiring, or do you need personal protection equipment?

A. Jana Grienke: This changes rapidly; currently, we are having most of our care providers wearing a face shield.

Sharda Kohli: We have limited inventory, and the requirements are rapidly changing. The ideal situation is to mask each patient and staff. For our therapists in our main teaching facility, we are implemented that they must wear masks and goggles for all patients.

Q. With all the stress that this is putting on our healthcare workers do any of your organizations have anything in place to help with employee stress during this time?

A. Jana Grienke: We just implemented a mental health hotline specifically for employees to be able to speak to a provider from our Department of Psychiatry. It's going to be staffed 24 hours a day, seven days a week, and it's used to discuss mental health issues and stress, learn some stress management strategies, and then get referrals if needed.

Debra Corbin: Some departments are implementing speakers and things to give the staff when they come in in the morning, basically saying we're all in this together. So that's what we're doing. We're sharing articles as we get them about taking care of yourself and support that way.

Sharda Kohli: At the University level, they have a hotline available. It's staffed by our Psychiatry Department. They're trying very much to engage people and have calendar invites to join a 10-minute mental health break. It's encouraging us to get up and move to do different things.

Watch the full webinar to hear about the following:

Rules regarding the reception areas or hoe many people can be in a room
Use of homemade masks in facilities
Deferring treatment based on clinical criteria for patients
Scanning employees for infections
Screening staff before entering the facility
Opinions on if people are not receiving treatment for fear of catching COVID-19
Daily physician huddles; what's working, what's not
Treatment for someone who tests positive for COVID-19
Plans in place if staff tests positive

Read the full transcript here

We want to hear from you!

Share what your organization has done during the pandemic. Any stress-relieving tips you can share with fellow radiation oncologists?

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