OR Manager - July 2020 - 21

COVID-19
Since becoming a HWW, Heartland
has maintained its normal daytime staff
schedules but also added " unusual
late hour staff " for patients who require
overnight stays. Thus far, staff have not
had to work those hours, but if they do,
they will be paid time and a half, she
says.
Any patient needing more recovery
time may stay at the ASC, but for something
like cardiac care, the patient will
be transferred to the hospital.
" We're still reviewing every patient
for comorbidities. If it wasn't safe for
them to come when we were an ASC,
it's still not safe for them to come while
we're functioning as a HWW, " she
notes.
How long might Heartland retain
HWW status? Hoeft-Hoffman doesn't
know, but she notes that hospitals in
her area have not been as overwhelmed
by COVID-19 patients as had been
anticipated. " Even if we have it for 6
weeks, we will get more revenue for
those Medicare patients, " she says.
As of late May, she notes, there was
a bill in the state legislature to allow
ASCs to keep patients for overnight
stays.
" The legislature goes back into session
July 20, and our lobbyist is going
to push for an emergency clause to be
added so that we don't have to wait
90 days for the bill to go into effect. If
that happens, when we have to give up
the HWW, we won't be prevented from
keeping a patient for 23 hours and 59
minutes, " she notes.
If the bill were to pass, she adds,
Heartland would hire additional staff for
overnight shifts.
Preparing for the future
In the event of a second wave, would
she apply again for a HWW designation?
" Maybe, " she says. " I'm going to monitor
to see how many Medicare A cases
we did to know if the reimbursement
was worth the extra work for my staff. "
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The impact on staff even for a facility
like Heartland, which has had less
disruption than elsewhere in the country,
includes family concerns such as
home-schooling children, spouses who
have been furloughed, and other life circumstances
that affect their emotional
well-being, Hoeft-Hoffman notes.
" We have an employee assistance
plan, and our health insurance has
added telemedicine for behavioral
health, " she says. " I worry about the
long-term emotional impact of this pandemic.
There's so much going on outside
of work. "
Hoeft-Hoffman advises OR leaders to
" overcommunicate " in a crisis because
that strategy is better than leaving people
in the dark, however unintentional.
With hindsight, she believes greater use
of virtual meeting platforms, in addition
to written communication, would be
helpful to keep staff informed.
" My clinical director and clinical
manager were on the every-other-day
rotation to limit their exposure, and
I worked at home part of the time
to avoid exposure, " she adds. " We
weren't always here on the same
days as our medical director, which
tends to break down communication
somewhat. "
Hoeft-Hoffman believes Heartland's
leaders have done the most important
things to ensure safety, and she feels
confident about their ability to manage
in the event of a second wave.
Nonetheless, she notes, it's important
to stay on top of changes as they
occur and anticipate what may happen
in the future.
She expects to have a busy summer,
with an uptick in patients coming to
Heartland for pain injections and other
procedures. " Patients are reluctant to
go to the hospital, " she says. " Once
people feel more comfortable about
having elective surgery, they will choose
to go to an ASC. " ✥
-Elizabeth Wood
OR Manager | July 2020
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OR Manager - July 2020

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