What Community Cancer Centers Need to Know About COVID-19

Apr 9, 2020By Dr. Jeff Patton, Dr. Lee Schwartzberg and Dr. Jeffrey Vacirca

By: Dr. Jeff Patton, CEO OneOncology, Dr. Lee Schwartzberg, Chief Medical Officer Onecology and Dr. Jeffrey Vacirca, Board Member OneOncology

As incidence of the COVID-19 pandemic increase in U.S. communities, the needs of cancer patients, and the healthcare heroes caring for them, are at the forefront of our attention and action.

As the crisis unfolds, we will share recommendations from our physician leaders for community oncology practices organized by risk and focused on patients, physicians and staff.

We will keep our recommendations updated on this page as they are subject to change. Sharing resources is one way we can work together to support community oncology during this pandemic.

Low Risk Patient Strategy

Appointment rescheduling:

Reschedule all non-essential treatments, such as screenings, six-month or annual check-ups for those without active cancer, while focusing on treating those with active cancers.
Allow only one family member/caregiver with each patient and none under the age of 16.

Screening:

Screening patients for the following prior to or immediately upon arrival to the clinic:
- Been in close contact with someone who has been diagnosed with COVID-19 during the last 14 days.
- History of travel to or have been in close contact with someone who traveled to areas of widespread or community COVID-19 transmission during the last 14 days.
- Symptoms of COVID-19 (fever, cough, shortness of breath).
- Screening for fever for all individuals entering clinics, especially at sites with higher incidence of documented COVID-19 infections.
Those that screen positive should contact their healthcare provider. Importantly, screening centers are beginning to get stood up in communities around the country.

Utilization of tele-health services:

Medicare describes three different visit types; telehealth visits, virtual check-ins and e-visits the agency has broaden access with the emergency declaration. CMS or a third-party payer may require consent for these services. Please see CMS guidance as of March 17, 2020.
Place of Service Codes are two-digit codes placed on healthcare professional claims to indicate the setting in which a service was provided. Per CMS guidance, this will allow practices to bill telehealth visits as “In Office” visits for reimbursement with your normal E&M's. Please see the CMS Telemedicine Provider Fact Sheet for more information.
As of March 20, 2020, some payers have moved to reimbursing for remote visits as though they happened in person.
A full list of codes can be found on the current CMS Fact Sheet.

Medium Risk Patient Strategy

Active non-symptomatic patients:

Physicians are best equipped to work with their patients regarding treatment regimens during this time, but generally patients on active treatment without symptoms should continue with their treatments.
Patients and care teams must be in regular communications with patients in active treatment to ensure their treatments continue and so their exposure risk is minimized.

Patients with fever on active treatment:

Patient who call in with fever who are on chemotherapy need to be seen by their oncologist or a designated provider who is assigned to evaluate these patients. These patients will need to be triaged – to their homes, isolation or area hospitals when necessary depending on their history and symptoms. These patients will likely undergo testing for influenza and COVID-19.

High Risk Patient Strategy

Vulnerable patients:

Patients with Neutropenic fever need to be seen by their physician and treated with IV antibiotics and other neutropenic precautions to prevent sepsis. Some of these patients could be sent to hospitals but isolating them in community clinics may be preferable.

If a patient is suspected of having COVID-19:

Immediately move the patient from the general waiting area into a well-ventilated space at least 6 ft or more away, preferably to an Airborne Infection Isolation Room (AIIR).
If an AIIR is not available, then the patient should continue to use a facemask for the duration of the visit.
Perform nasal swabs for influenza and COVID-19.
Notify appropriate clinic staff (provider, IPC staff, and administrators).
The patient’s provider will determine the plan of care, including the recommended disposition (home or hospital).

If the patient does test positive for COVID-19:

Daily telephone and/or tele-health visit with the patient, with disposition based on evolving symptoms.
Notifying the local or state health department.

Staff Strategy

Instill universal public health precautions:

Perform hand hygiene (use 60% - 95% alcohol-based hand sanitizers or wash with soap and water for 20 seconds). Implement respiratory hygiene and cough etiquette including the use of a face mask, tissues, and coughing into sleeve, if tissues aren't available.

Wear full protective gear:

Always use personal protective equipment (PPE), including gowns, gloves, and face masks for patients receiving chemotherapy.

Change Non-clinical meetings:

Change administrative meetings and tumor boards to virtual meetings and utilize physician communication platforms to discuss patient cases.
Non-clinical departments should implement work-from-home policies.

Patient Rooms:

Clean and disinfect the room and equipment with a healthcare grade disinfectant in the same manner used for other airborne illnesses before reusing.
Staff cleaning rooms should use full PPE if patients were confirmed or suspected of contracting COVID-19.

Self-monitor and report:

Staff and providers who use appropriate PPE or who have brief interactions with patients with suspected or confirmed COVID-19 are considered to be at a low exposure risk.
All staff who have traveled oversees or whose families have traveled abroad must report that to the HR department
Staff should also self-monitor and report acute respiratory symptoms to their provider and appropriate clinic leadership.

Exposed staff:

Staff who believe they’ve been exposed to COVID-19 must follow the Centers for Disease Control and Prevention (CDC) protocol to help prevent the disease from spreading and to care for themselves.
These steps include self-quarantining by staying at home until cleared by their provider, separating yourself from other people and animals in your home.
Staff need to call their healthcare provider, monitor their symptoms and seek medical care if the symptoms worsen.