Healthcare Coordination Partner Briefing on COVID-19 Response

The briefing held on April 24, 2020, by Dr. Parham Jaberi, MD, MPH, Chief Deputy Commissioner of Public Health and Preparedness, focused on coordinating healthcare efforts in response to the COVID-19 pandemic. The Healthcare Coordination Committee, led by Dr. Jaberi, aims to coordinate over 120 public and private healthcare members across various sectors to effectively respond to the crisis. The briefing outlined the current subcommittees and future plans for acute care, medical surge, disaster medical advisory, emergency services, telehealth, pharmacy services, testing, long-term care, medical workforce, and provider wellness. This comprehensive approach ensures efficient coordination and response to the evolving challenges posed by the pandemic.

• Healthcare
• COVID-19
• Coordination
• Response
• Pandemic

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1. COVID-19 Response Healthcare Coordination Partner Briefing April 24, 2020 Parham Jaberi, MD, MPH Chief Deputy Commissioner, Public Health and Preparedness

2. Healthcare Coordination Committee Chair - Dr. Parham Jaberi, VDH Chief Deputy Commissioner Staff Support - Kelly Parker; Director of Emergency Preparedness, VHHA; Kathryn Gilley, Director of Advocacy Engagement, VHHA Mission - To coordinate the efforts of the healthcare and medical community in response to the COVID-19 pandemic. Weekly Meetings Tuesday 2-3:30 pm, Est. 3/17/2020 Membership > 120 Members Public & Private, Pre-Hospital, Acute, Post-Acute, Healthcare Associations, Professional Associations, Group Practices, Free Clinics.

3. Governor Cabinet COVID-19 Unified Command March 12, 2020 Governor s Situation Room State Agency Readiness Legal & Policy Group Virginia Emergency Support Team Equity & Inclusion Group COVID-19 Task Force Leadership Group VDH, VDEM, VSP, OAG, DHRM JIC Intergovernmental Affairs Logistics VDEM/DGS/VDH/VITA Operations VDH/VDEM Finance VDEM/VDH Recovery VDEM Planning VDH/VDEM/VANG Regional Support Branch Emergency Support Functions Current Plans Data Unit Future / Contingency Plans Health Coordination Group SITSTAT RESTAT Local Coordination Group Containment Group Public Health / VDH IMT Private Sector Group Training, Education & Exercise Group

4. Five Weeks Later

6. Healthcare Coordination Evolving Subcommittees Current Subcommittees (Discussed Today) (Deferred Discussion) Acute Care/Medical Surge Virginia Disaster Medical Advisory Committee (VDMAC) Emergency Medical Services (EMS) Telehealth Pharmacy Services VDH Testing, VHHA Testing To be rolled into State Task-Force Long-Term Care (DMAS) To be rolled into State Task-Force Medical Workforce Led by MSV & VDH-MRC Provider Wellness Led by DBHDS

7. Acute Care/Medical Surge Acute Care/Medical Surge Chair, Dr. Mike McDermott, VHHA Board Chair, (President and CEO, Mary Washington Healthcare) Staff Support Kelly Parker, Director of Emergency Preparedness, VHHA Mission To coordinate the health and medical response efforts of acute care facilities. Distributed personal protective equipment (PPE) to frontline health care workers Expanded the Commonwealth s capacity for testing suspected COVID-19 patients. Increased capacity to treat COVID-19 patients within licensed healthcare facilities (EO 52) Planning for care of ill individuals in other healthcare/alternate settings Data Information & Sharing (https://www.vhha.com/communications/virginia-hospital-covid-19-data-dashboard/)

8. Executive Order 52 (2020): INCREASES IN HOSPITAL BED CAPACITY IN RESPONSE TO NOVEL CORONAVIRUS (COVID-19) Directive: Therefore, by virtue of the authority vested in me by the Constitution of Virginia, by 2.2-103 and 44-146.13 et seq. of the Code, and notwithstanding the provisions of Article 1.1 of Chapter 4 of Title 32.1 of the Code, I direct the State Health Commissioner, at his discretion, to authorize any general hospital or nursing home to increase licensed bed capacity as determined necessary by the Commissionerto respond to increased demand for beds resulting from COVID-19. Notwithstanding Virginia Code 32.1-132, I further direct any beds added by a general hospital or nursing home pursuant to an authorization of the Commissioner under this Order will constitute licensed beds that do not require further approval or the issuance of a new license.

9. Order of Public Health Emergency Two NOW THEREFORE, the Governor and State Health Commissioner hereby issue this Order prohibiting all inpatient and outpatient surgical hospitals licensed under 12 VAC 5-410, freestanding endoscopy centers, physicians offices, and dental, orthodontic, and endodontic offices in the Commonwealth from providing procedures and surgeries that require PPE, which if delayed, are not anticipated to cause harm to the patient by negatively affecting the patient's health outcomes, or leading to disability or death. This does not include outpatient visits delivered in hospital-based clinics. This Order does not apply to the full suite of family planning services and procedures nor to treatment for patients with emergency or urgent needs. Inpatient and outpatient surgical hospitals licensed under 12 VAC 5-410, free-standing endoscopy centers, physicians offices, and dental, orthodontic, and endodontic offices may perform any procedure or surgery that if delayed or canceled would result in the patient's condition worsening. Outpatient surgical hospitals are encouraged to work with their local inpatient hospitals to assist with surge capacity needs.

10. Medical Surge Increases Medical Surge Increases EO 52 & Public Health Emergency Two EO 52 & Public Health Emergency Two 45 Acute Care Facilities, 2 LTCFs (As of 4/22/2020) 115 Requests (One Facility with multiple areas of expansion; PACU/Med-Surge/New Hospital Wing) Processed by VDH Office of Licensure and Certification (OLC) Approved by State Health Commissioner Total Added Capacity ~3,500 beds (As of 4/22/2020) 1,582 ICU beds, >500 from PACUs, >100 from ambulatory/day surgery, >50 Cardiac Cath Holding... 1,719 med/surge beds 174 "flex" beds 42 nursing home beds

11. Stay the Course: Future Depends on Policy Weekly New Confirmed Cases Week ending 4/12/20 4/19/20 4/26/20 5/3/20 5/10/20 5/17/20 5/24/20 5/31/20 6/7/20 6/14/20 6/21/20 6/28/20 Unmitigated Slow Jun10 5,518 8,502 13,076 19,881 29,567 42,312 57,679 73,380 85,874 89,390 85,226 91,648 Pause Jun10 2,469 2,599 2,742 2,944 3,151 3,345 3,558 3,770 3,962 4,144 4,470 7,850 11,846 25,712 53,562 101,876 164,527 200,184 182,818 136,652 84,016 46,350 23,363 11,366 Numbers are medians of projections Presented - April 13, 2020 11

12. Alternate Care Facility Planning Alternate Care Facility Planning Hospital Surge Hospital Surge Three sites identified, tactical pause on build-out based on updated modeling. o Dulles EXPO center (Dulles) o Greater Richmond Convention Center (Richmond) o Hampton Roads Convention Center (Hampton) General Concept: COVID-positive, Non-acute (non-ICU), convalescent car/recovery and palliative care facilities. VDEM, VA National Guard, VDH, FEMA, Sponsoring Healthcare Facility , Local Government/Law Enforcement

13. Medical Surge Planning Medical Surge Planning Refocus on Congregate Settings Refocus on Congregate Settings Department of Corrections - Week of April 20, 2020 Long Term Care Facilities - Week of April 27, 2020 Pending Meetings Department of Behavioral Health and Developmental Services Facilities Local Jails/Correctional Facilities Other Congregate Settings Courtesy: VANG/VDEM Presentation

14. VDMAC VDMAC Virginia Disaster Medical Advisory Committee Virginia Disaster Medical Advisory Committee Chair, Dr. Mike McDermott, VHHA Board Chair, (President and CEO, Mary Washington Healthcare) State Support, Dr. Walker-Harris, Deputy Secretary of Health and Human Resources Staff Support, Sean Connaughton, President and CEO of Virginia Hospitals and Healthcare Association Mission Develop recommendations on the management and mitigation of medical surge in acute healthcare facilities; assist in allocation of scarce resources. VDMAC Activation - Approved 3/18/2020 Crisis Standards of Care Contingency Care - Approved 3/20/2020 Request to Restrict Non-Urgent Medical Procedures - Approved 3/25/2020 Review of Additional Beds Under EO52 Approved 4/6/2020 Guidance of Healthcare Personnel Potentially Exposed to COVID19 Approved 4/7/2020 Amend COVID-19 Crisis Standards of Care Plan to Address Health Equity Approved 4/20/2020

15. EMS Subcommittee EMS Subcommittee Chair, Karen Owens, VDH Office of EMS (Division Manager of EMS Ops) Mission - To inform and coordinate the EMS Response for the Commonwealth. Weekly Calls with the 11 Regional EMS Councils Released EMS white paper regarding transport to alternate facilities (i.e. urgent care or other settings besides traditional ED; under discretion of the EMS Agency Operational Medical Director) Identifying trends with potential concern about people are not calling EMS when they need should for time-sensitive illnesses. Continue efforts to work with 911 centers to ensure they re using CDC guidelines. Improving coordination and use of PPEs with healthcare facilities request of EMS personnel to don & doff PPE when bringing patient into facility; lack of clarity in sharing of PPE.

16. Telehealth Subcommittee Telehealth Subcommittee Chair, Dr. Karen Rheuban (Professor, UVA, Medical Dir of UVA Office of Telemedicine) Support, Brent Rawlings, Senior VP and General Counsel (VHHA) Mission To evaluate and promote capabilities to apply telemedicine/telehealth to COVID-19 aimed at reducing spread, alleviating system capacity demands, and providing an alternative to in-person care. Educating Providers on Use of Telehealth Services Reimbursement Parity for telemedicine vs office visits (DMAS heavily involved) Identifying opportunities for funding of new initiatives (i.e. F.C.C.) Evaluated a Forward Triage Tool (i.e. Buoy Health) Discussed Enforcement Discretion by OCR for telehealth remote communications during the COVID-19 nationwide public health emergency; OAG provided guidance on 32.1-127.1:03. Health records privacy. EO57 A healthcare practitioner may use any non-public facing audio or remote communication product that is available to communicate with patients. This exercise of discretion applies to telehealth provided for any reason regardless of whether the telehealth service is related to the diagnosis and treatment of COVID-19. Will be working with Health Plans to see if devices for patients can be covered. VHHA sent a letter with other organizations, to the Workers Compensation Commission requesting telehealth be a covered benefit during the COVID-19 crisis.

17. Pharmacy Services Pharmacy Services Chair, Dr. Stephanie Wheawill, VDH Division Director for Pharmacy Services Mission - To inform and coordinate special provisions around pharmaceutics and assist with surge planning by considering scope of practice. Main Concerns - Tackling drug supply challenges Increased demand (albuterol, atropine, azithromycin, hydroxychloroquine, and medications for ventilator patients - propofol/anesthetics/fentanyl), Higher doses necessary for COVID-19 patients Disruption of usual supply chain. Hospitals are still getting the medications they need, but that supply is beginning to dwindle and shortages may occur if manufacturers don t accelerate production HHS request submitted Monitor conservation strategies (alternating meds, establishing alternatives, extending drip times, etc.) and additional actions taken regarding decontamination, disposal and wastage of medications. Coordination / Communication with Retail Pharmacy Sites offering Testing.

18. Support of other Unified Command Response Support of other Unified Command Response Functions Functions Data Analytics Outreach & Education Providers - MSV Weekly Meetings, Medical Society of Northern Virginia, Medical Specialty Groups (Led by Dr. Remley) VDH Weekly Partner Debriefings Messaging via VHHA, Clinician s Letters Media Requests and Inquiries

19. Questions Parham Jaberi, MD, MPH Chief Deputy Commissioner Virginia Department of Health Parham.Jaberi@vdh.Virginia.gov Cell: 804-357-0297