COVID-19 Updates and Resources


Clinical Information & Resources

Alameda County

Alameda County Public Health Department of Communicable Disease Section: (510) 267-3250 from 8:30 AM - 5:00 PM on weekdays. After-hours calls should be directed to (925) 422-7595 and ask for the public health duty officer on call.

Contra Costa County

City of Berkeley

Berkeley Public Health Division: (510) 981-5292 from 8:00 AM - 5:00 PM on weekdays. After-hours calls should be directed to (510) 981-5911 and ask for the Health Officer on call.

Specialty-Specific Guidelines

A comprehensive list of specialty-specific COVID-19 guidelines, compiled by MIEC.

California Department of Public Health

Center for Disease Control and Prevention

World Health Organization

Practice Management Resources

ACCMA Webinar Managing Your Practice Through COVID-19

This one-hour recorded training provides private practice physicians with the information needed to manage the COVID-19 crisis while maintaining your practice. Learn how to handle layoffs with a labor law expert, manage the cash flow in your practice, and learn more about telemedicine codes as you navigate your practice through this challenging time.

Guidance for Health Care Facilities

Guidance for Licensed Facilities (04/14/20)

Alameda County Public Health Department (ACPHD) and Contra Costa Health Services (CCHS) each issued Orders for all Licensed Facilities and Other Agencies, as well as their staff, contractors and any essential visitors entering those sites to comply with guidance to control the spread of COVID-19. The Orders become effective at 12:01 AM on Tuesday, April 14, 2020.

New guidelines for licensed facilities include:

  • Temperature check for all staff, contractors, and other essential visitors before entering the facility.
  • All individuals entering the facility must self-evaluate for mild to moderate COVID-19 symptoms, including fever, sore throat, coughing, shortness of breath, or general weakness in the last 7 days.
  • All individuals with a temperature of 100° F or 37.8° C or greater should be prohibited from entering the facility.
  • All staff, residents, and other essential visitors should wear masks to cover their nose and mouth while in the facility and, for residents, outside their rooms. Appropriate and recommended PPE must be worn by staff when available if there is a confirmed or suspected COVID-19 case at the facility.
  • All group activities and communal dining must be canceled. Staff and residents should maintain a physical distance of 6 feet apart when leaving their rooms.
  • If a resident who is suspected or confirmed of having COVID-19 is being transferred to an acute care hospital, the hospital, EMS, and transport agencies should be notified. The facility should notify EMS and the receiving hospital if the facility already has COVID-19 cases.
  • Avoid, as much as possible, staffing scenarios that use employees who have worked at another Licensed Facility or Other Agency in the past 14 days. Facilities must keep a daily log of employees present, identifying any other facilities the employees have worked at in the previous 14 days, and that log must be produced immediately if requested by any staff member of the ACPHD.

The Alameda-Contra Costa Medical Association is closely partnering with the Alameda County Public Health Department (ACPHD)'s Long-Term Care Facility Task Force. This new order aims to keep patients safer by making compliance mandatory. Review the full order here.

Contra Costa Health Services has issued a similar order, outlining the same guidelines above.

Financial Assistance Resources

Intuit Aid Assist

Intuit Aid Assist is a free service that allows businesses, self-employed, contractors, and others to understand and access different business relief programs. Individuals and businesses can complete a loan eligibility assessment to see if they qualify for any federal funding programs.

 

New Paycheck Protection Program 

The federal economic relief law includes nearly $350 billion in funding to create a Paycheck Protection Program (PPP) that will provide small businesses and other entities with zero-fee loans of up to $10 million. Up to 8 weeks of average payroll and other costs will be forgiven if the business retains its employees and their salary levels. Principal and interest are deferred for up to a year and all borrower fees are waived. This temporary emergency assistance through the Small Business Administration (SBA) and the Department of Treasury can be used in coordination with other COVID-financing assistance established in the bill or any other existing SBA loan program. The bill requires the SBA Administrator to set a cap on how much a bank can earn to process loan applications and prioritize underserved borrowers, including those in rural communities, minorities, women, and veterans. You can apply through any existing SBA lender or through any federally insured depository institution, federally insured credit union, and Farm Credit System institution that is participating.  Click here for more information about the program. Click here for an information sheet for borrowers.

 

Economic Injury Disaster Loan Program and New Grant 

SBA will work directly with state governors to provide targeted, low-interest loans to small businesses and non-profits that have been severely impacted by the Coronavirus (COVID-19). The SBA’s Economic Injury Disaster Loan program provides small businesses with working capital loans of up to $2 million that can provide vital economic support to small businesses to help overcome the temporary loss of revenue they are experiencing. 

The federal economic relief law includes $10 billion in grant funding to provide an advance of $10,000 to small businesses and nonprofits that apply for an SBA economic injury disaster loan (EIDL) within three days of applying for the loan. EIDLs are loans of up to $2 million that carry interest rates up to 3.75% for companies and up to 2.75% for nonprofits, as well as principal and interest deferment for up to 4 years. The loans may be used to pay for expenses that could have been met had the disaster not occurred, including payroll and other operating expenses. The new $10,000 EIDL grant does not need to be repaid, even if the grantee is subsequently denied an EIDL, and may be used to provide paid sick leave to employees, maintaining payroll, meet increased production costs due to supply chain disruptions or pay business obligations, including debts, rent, and mortgage payments. Eligible grant recipients must have been in operation on January 31, 2020. The grant is available to small businesses, private nonprofits, sole proprietors and independent contractors, tribal businesses, as well as cooperatives and employee-owned businesses. 

A business that receives an EIDL between January 31, 2020, and June 30, 2020, as a result of the COVID-19 disaster declaration is eligible to apply for a PPP loan or the business may refinance their EIDL into a PPP loan. In either case, the emergency EIDL grant award of up to $10,000 would be subtracted from the amount forgiven in the payroll protection plan. To apply for a COVID-19 Economic Injury Disaster Loan, click here

 

Express Bridge Loans 

Express Bridge Loan Pilot Program allows small businesses who currently have a business relationship with an SBA Express Lender to access up to $25,000 with less paperwork. These loans can provide vital economic support to help small businesses overcome the temporary loss of revenue and can be term loans or used to bridge the gap while applying for a direct SBA Economic Injury Disaster Loan. If a small business has an urgent need for cash while waiting for decision and disbursement on Economic Injury Disaster Loan, they may qualify for an SBA Express Disaster Bridge Loan. 

 

AMA Tips for Keeping Your Practice in Business During the COVID-19 Pandemic: 

Physician practices managing patients during the COVID-19 pandemic are confronting new and unique operational and business challenges. This checklist provides high-level guidance for practice owners and administrators. Check out the AMA COVID-19 checklist to stay up to date.

 

Disaster Relief Loans

Small businesses in Alameda and Contra Costa counties are eligible for disaster relief loans from the US Small Business Administration as a result of COVID-19:

Financial Toolkit for Medical Practices

During the COVID-19 pandemic, physician practices are confronting operational and business challenges as they continue to deliver high-quality care to their patients. Medical practices will need to make difficult choices about whether to make significant changes that could include changing how they deliver care or even closing their practices. CMA has compiled a financial toolkit for medical practices:

PPE Supplies, Requests, and Guidances

The ACCMA has developed PPE Guidance for Independent Practices, bringing together resources and information regarding PPE requests and PPE use. If you have any questions or any additional information to add to the document, please contact the ACCMA by calling 510-654-5383 or emailing accma@accma.org.

Please see the attached table with contact information for organizations that are able to provide personal protective equipment (PPE), medical supplies, medical equipment, and cleaning/disinfecting supplies.

CMS COVID-19 Regulatory Changes

CMS has taken proactive steps through 1135 waivers to rapidly expand the Administration’s efforts against COVID-19. As a result, new blanket waivers have gone into effect, with a retroactive effective date of March 1, 2020, through the end of the emergency declaration.

Resumption of Non-Urgent Health Care Services - Alameda County

On May 13, Alameda County Public Health Department released a health advisory concerning resumption of non-urgent health care services. The health alert indicates that providers and facilities are encouraged to gradually resume full scope of services when possible and safe to do so, based on California Department of Public Health (CDPH) and Alameda County Public Health Department (ACPHD) guidance.

Review the full health advisory, including actions requested of clinicians and healthcare facilities, here.

Medicare Advance Payments

Medicare will start accepting and processing the Accelerated/Advance Payment Requests immediately. 

California physicians should submit a request to Noridian, California's Medicare contractor. Physicians can request 100% of their historical Medicare payment amount for a three-month period. CMS anticipates that the payments will be issued within seven days of the provider’s request. Repayment of the advance payments is due 120 days after the issuance of the advance payment. Physicians have 210 days from the issuance of the advance payment to repay the entire balance due to CMS. 

For more information, see the CMS fact sheet on the application process. 

Medicare Accelerated and Advance Physician Payments 

The Centers for Medicare & Medicaid Services (CMS) on March 28, 2020, announced an expansion of its accelerated and advance payment program for participating Medicare physicians and hospitals. This expansion is intended to lessen the financial hardship of providers facing extraordinary challenges related to the COVID-19 pandemic and help with cash flow problems that many physician practices are experiencing. To qualify for accelerated or advance payments, the physician must: 

  • Have billed Medicare for claims within 180 days immediately prior to the date of signature on the provider’s/ supplier’s request form; 

  • Not be in bankruptcy; 

  • Not be under active medical review or program integrity investigation; and 

  • Not have any outstanding delinquent Medicare overpayments. 

Medical Practices Should Stay Open

On March 31, 2020, Alameda County and Contra Costa County (along with several other Bay Area counties) issued legal orders directing residents to shelter at home. These orders supersede the previous shelter in place orders. The order limits activity, travel, and business functions to only the most essential needs. The guidance comes after substantial input from the U.S. Centers for Disease Control and Prevention (CDC) and best practices from other health officials around the world.

The order defines essential activities as necessary for the health and safety for individuals and their families, and includes “health care operations” and specifically states:  

  • For purposes of this Order, individuals may leave their residence to work for or obtain services at any “Healthcare Operations” including hospitals, clinics, dentists, pharmacies, pharmaceutical, and biotechnology companies, other healthcare facilities, healthcare suppliers, home healthcare services providers, mental health providers, or any related and/or ancillary healthcare services. “Healthcare Operations” also includes veterinary care and all healthcare services provided to animals. This exemption shall be construed broadly to avoid any impacts on the delivery of healthcare, broadly defined. “Healthcare Operations” does not include fitness and exercise gyms and similar facilities. 

CMA Guidelines for Reopening CA Health System

The California Medical Association has released guidelines for reopening California's health care system, which were developed by a task force comprised of practicing physicians from different parts of the state and different sized practices.

Click here for a comparison grid showing a side-by-side rundown of CMA’s guidelines for reopening the health care system in California vs. the guidelines released by the California Department of Public Health, as they pertain to physicians.

CDPH Guidelines for Reopening Practices

The California Department of Public Health has released guidelines on resuming California’s deferred and preventive health care for physicians, hospitals, dentists, and skilled nursing facilities.

Click here for a comparison grid showing a side-by-side rundown of CMA’s guidelines for reopening the health care system in California vs. the guidelines released by the California Department of Public Health, as they pertain to physicians.

HIPAA Compliant E-Signature Companies

Mary Jean Sage, of The Sage Associates, has compiled a list of companies that physicians can use when looking for a HIPAA Compliant E-Signature Company. Most physicians may be able to use the e-signature company that comes with their EHR/PM system, however other e-signature company options are available.

Most of the companies on this list have websites where users can watch a demo and obtain pricing.

CDC "Prepare to Care for COVID-19"

The Centers for Disease Control and Prevention (CDC)'s "Prepare to Care for COVID-19" is a resource clinicians can use to care for patients with COVID-19. This resource contains practical tools for treating COVID-19 patients and will be regularly updated to help clinicians adapt to the ongoing COVID-19 crisis.

AMA Physician Practice Employee Cost Guide

The American Medical Association (AMA) released a guide tailored to physician practices, helping physician employers consider their options in controlling practice costs. Key options include redeployment, outside activities, compensation changes, workforce reduction, benefit modifications, legal compliance and stimulus relief considerations. Review the full guide to learn more key options for physicians to consider to limit practice costs.

Templates/Resources

Telemedicine

ACCMA Telemedicine Series

Telehealth services are expanding rapidly during the COVID-19 crisis. In partnership with Bay Area medical associations, the ACCMA teamed up with experts to develop a comprehensive webinar series to help physicians swiftly ramp up their telemedicine capabilities, from technology to practice implementation to coding. Experts discuss choosing a telemedicine platform; compliance; privacy and security considerations; billing and payment; policies, procedures, and workflow; informing your patients; and malpractice. Physicians who have experience practicing telemedicine shared their practical reflections.

To access these on-demand webinars, visit accma.org/Telemedicine-Series.

Reimbursement/Payors

CMA is working to obtain information on payor reimbursement policies related to COVID-19 and telemedicine/telephone appointments. As of now, the ACCMA is aware of the following policy announcements:

ACCMA Guidance on Getting Telemedicine Up and Running Quickly

Medicare Telehealth Changes - Codes and Modifiers

CMS added to the list of services that can be provided via telehealth to include additional hospital services, home visits, and domiciliary services. Additional services that are temporary additions to the services that may be performed via telehealth include care planning for patients with cognitive impairment, psychological and neuropsychological testing, physical therapy, and occupational therapy. These services can be provided to new or established patient visits.

In order to bill office visits or any of the services mentioned above, you must have interactive, real-time audiovisual with the patient. If phone only, look at the phone codes that are now covered.

To view a full list of payment for phone calls and a list of Medicare Telehealth Services, please review the attached article, written by Mary Jean Sage of The Sage Associates.

Medicare issued another change to telehealth rules on April 30, 2020 with an interim final rule with comment period (IFC). The rule outlines changes to a number of issues including: 1) Advance practice providers ordering and furnishing diagnostic tests; 2) Hospital outpatient departments; and 3) Hospital based clinics billing an originating fee. However, the most significant change for physicians is the new rule regarding payment for Telephone Calls. Medicare will now reimburse telephone calls (99441 - 99443) at the rate of an in-person office E/M service. Read more about the new rule in the article by Mary Jean Sage of The Sage Associates.

COVID-19 Volunteer Opportunities

Alameda County

Alameda County

In anticipation for a greater surge of COVID patients, Alameda County is collecting information from those who work in medical and health care settings, who are willing to work shifts in alternate patient care locations within the county. We are looking for: Doctors, physician assistants, nurse practitioners, nurses, EMTs, paramedics, medical assistants, phlebotomists, respiratory techs, ER techs, X-ray techs, pharmacists, pharmacy techs, social workers, registration clerks, nutrition staff, housekeeping, IT, security, maintenance, etc. There may also be need for translation services.

If you are available and willing to work in any of these capacities, please complete these two required steps:

  1. Register in the COVID-19 Medical Health Personnel Database
    • If you are willing to volunteer in any of these positions, please note “VOLUNTEER” in the section asking for whom you work.
  2. Register in the California Health Corps System (formerly DHV)
    • Under the Organizations Section, click + Add Organizations, and Sign-up in the Alameda County Unit (see image below) 

For those who already registered in the DHV System/California Health Corps, please update your profile.

As a reminder, we are only gathering information on the prospective workforce. Currently, there is no specific mission/assignment, nor established schedules or locations. As the situation evolves and planning takes more definitive shape, we will contact you to see if you are still available. You will not be contacted if you did not complete the two required steps above.

Contra Costa County

Contra Costa County

Contra Costa is making effort to extend its health care workforce (HCW) through the hiring of new HCW staff through both our county personnel and through statewide efforts to deploy HCWs at the state level as both paid and volunteer staff. Below are the links to submit applications for this work:

  1. To submit applications for temporary employment with Contra Costa County, please submit an online application. Medical Professionals needed: Physicians, RN, LVN, Certified Medical Assistant, D.I. Techs, Lab Scientists, etc. Click here for the application link.
  2. To submit an application to be either hired or deployed by the Statewide effort, enroll online here. During the enrollment process, you have an opportunity to select “Organizations” and you may select “Contra Costa County Unit” to indicate your desire for placement in Contra Costa (along with other counties where you are willing to serve).

Physician Wellness

ACCMA Resources Toolkit

The ACCMA has put together a free toolkit of resources that address the day-to-day needs of East Bay physicians of all career stages and in all modes of practice, from food and grocery delivery services to exercises that can be done at home. Click here to access and download the toolkit. 

Tips for Physicians to Protect Themselves and Their Families

Click here for tips on what to do before going to work, at work, and after work/coming home to protect yourself and your family. Tips include how to create a hot zone (contaminated area) near your home entrance and how to take care of your skin. Courtesy of the TPMG Diablo Health and Wellness Team.

Confidential Assistance through ACCMA Advisory Committee on Physician Wellbeing

Confidential assistance from trusted colleagues who serve on the ACCMA Advisory Committee on Physician Wellbeing. Committee members are available to provide immediate peer support at no cost. Click here to contact ACCMA.

RechargedMD Peer Discussion Groups

RechargedMD is offering ACCMA members complimentary online peer discussion and coaching specifically for physicians. With the guidance of a certified physician coach, physicians can receive and offer support, as well as learn from one another. Small groups will meet beginning on April 25 for 45 minutes per week for three facilitated sessions. After that, it will be $150 to participate in the program (usually $600). Go to rechargedmd.com/covid19support.

Physician Wellness Webinars

Physician Wellness - Coping with COVID-19

This one-hour, on-demand webinar led by Linda Hawes Clever, MD, MACP, offers practical, creative, and effective remedies to deal with the crush on personal and professional lives during the COVID-19 pandemic. It contains strategies, resources, and suggestions for handling physician wellness, as well as addressing questions and answers, as we listen and see the ingenuity, guts, and devotion with which we are addressing the harrowing challenges we all face as a profession, community, and nation. Discover how to reduce personal stress and learn healthy ways to contend with the impact of COVID-19.

Attached are some of the additional resources that Doctor Clever mentioned in her presentation. Other resources can be found here on the ACCMA COVID-19 webpage.

ACCMA Vetted Mental Health Professionals

Our resource list of counselors can provide you with confidential counseling or coaching services from vetted mental health specialists who are experienced in working with physicians. The ACCMA does not negotiate rates or pay for these consultations.

CMA Care 4 Caregivers Now

The Care 4 Caregivers Now program from the California Medical Association connects front-line health care workers with volunteer wellness coaches (physicians and nurses) trained to remotely and confidentially coach their peers to reduce their emotional exhaustion and burnout while improving resiliency. Go to cmadocs.org/care4caregivers or email CMAwellness@cmadocs.org.

Advocacy

ACCMA

March 29 - Mobile & Remote COVID-19 Testing Letter to the Mayors

On Sunday, March 29, the ACCMA drafted a letter to the Mayors of cities in Alameda and Contra Costa Counties regarding mobile and remote COVID-19 testing. The ACCMA understands that there is a high level of interest among East Bay cities, fire departments, and other organizations to increase the availability of mobile COVID-19 testing sites in our community. Accordingly, the ACCMA urges local cities, fire departments, community-based organizations, and others to incorporate a set of standards in any efforts to develop mobile test sites in our community, including:

  • Ensuring that testing is completed by licensed entities;
  • That all testing sites follow proper protocols to prevent further COVID-19 transmission;
  • That testing sites transmit all test results, both positive and negative, to appropriate public health officials; and
  • That testing sites have protocols in place for ensuring proper care coordination is occurring for each individual tested.

Review the full memo here.

March 13 - Physician Needs Letter to Governor Newsom

ACCMA coordinated with all Bay Area medical associations (representing 16,500 members) to send a letter to Governor Newsom on March 13, articulating what physicians need in order to help our communities 

CMA

ACCMA is continuously supporting CMA advocacy priorities during the COVID-19 crisis. Keep up-to-date on CMA's advocacy work by visiting their COVID-19 Advocacy section.

AMA

ACCMA continuously works to support the work of the AMA. Stay up-to-date on AMA's COVID-19 Advocacy work by visiting the Advocacy tab on their COVID-19 Resource Page.

Community Resources

Information for the General Public

Protect yourself and your community from getting and spreading respiratory illnesses like COVID-10. The following webpages provide local, state, and federal information and updates about COVID-19.

Wellness Tip of the Day - August 13

Medical Malpractice Litigation Peer Support

You don't have to go through medical malpractice litigation alone. The ACCMA offers free personal and confidential assistance for physicians threatened with medical malpractice, medical board investigations, and workplace disciplinary actions. Our Litigation Stress Program provides moral and emotional support from trusted colleagues who serve on the ACCMA Litigation Stress Subcommittee, and are intended to complement the support that physicians receive from their personal legal counsel and professional liability insurance company.

You may request a visit or phone consultation at no cost. For more information, go to https://www.accma.org/Litigation-Stress or contact the ACCMA at wellbeing@accma.org or (510) 654-5383, ext. 6307.

MIEC