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CORONAVIRUS

Practical guidance for medical office employers handling coronavirus

By Paul Edwards bio

We know there is a lot of information (and misinformation) out there about the coronavirus (COVID-19) and how to handle it in the workplace. Our goal is to provide you with guidance on how to handle this as an employer—practical solutions for the impact the coronavirus may have on your business.

If an employee is sick, can I send him/her home?

If an employee is objectively showing signs of being sick—flu symptoms, bad cold symptoms, coronavirus symptoms, or other—you are able to send them home so that they don’t pose a health risk to the rest of your team or other visitors to the office. Most employers encourage their teams to stay home if they are unwell, but don’t necessarily require it unless it appears to be a severe illness. With heightened health concerns right now, it’s okay to become much more strict about this.

Most employers also have some type of policy in their employee handbook about the employee getting a doctor’s note releasing them to work if they’ve been out for a certain amount of time. If your state, city, or county has a mandated sick leave rule, it likely has a restriction about when you can ask for a doctor’s note so be sure to follow those laws. 

You can’t require that an employee disclose their medical diagnosis to you, but you can require that they have a healthcare provider confirm in writing that they are able to return to work, or confirming that they are unable to work for a period of time, or that they have specific work restrictions. We recommend getting that documentation if you have concerns about someone’s health.

If I close my office and my employees are not working, I can’t afford to pay everyone’s full salaries. Can I pay them a reduced rate?

Having to shut down your business for a period of time is a financial strain for you, but it’s also a very serious financial issue for your staff who has to pay their rent, buy food, and support their families. It would be amazing if you could continue to pay everyone’s full salaries during an office closure, but we know that isn’t feasible for many companies particularly if it’s an extended period of time.

Since the employees are not actually working, you aren’t obligated to pay wages so the normal rules about rates of pay don’t apply. You could pay everyone for their normal number of workweek hours but at a reduced rate of pay. Alternatively, you could issue a set amount to everyone as a per diem or stipend to help them pay their bills.

Several state and county government agencies have been releasing official guidance. Here are some detailed resources that have come to our attention:

California’s Department of Occupational Safety and Health (Cal/OSHA) has released guidance for healthcare workers.

The California Department of Public Health, Immunization Branch, has released coronavirus information.

The New York State Department of Health has released guidance and established a coronavirus hotline.

Somerset County, New Jersey has a coronavirus resource page.

San Francisco, California issued a news release, declaring a local emergency to prepare for the coronavirus.

Communication in coronavirus emergency

We recommend you set up two types of communication plans to handle Coronavirus issues as they arise. One type is for what happens if lots of your employees end up home, whether working or sick, and the other one is to deal with the day-to-day issue of the saga which is being created by this unique outbreak.

In this guidance we frequently mention the option of having employees work from home. We understand that the vast majority of our members and readers provide face to face services. All of the talk about sending people home to work is not going to work for many employers. Ultimately, you may have to find a balance and come up with what works best for your business and team. Not everyone will get sick. Of those who may get sick, not all will get sick at the same time.

What should I do now to be prepared for or to prevent infection at the office?

We highly recommend reviewing the CDC’s guidance for employers. The CDC has been firmly established as a go-to reference for coronavirus preparation and facts. OSHA guidelines are also very informative for employers on this issue, particularly in the healthcare field.

Here are some practical steps you can take now to prevent an infection in the workplace:

Remind all employees to wash their hands thoroughly and frequently, and to cover their nose with the inside of their elbow when they sneeze. The CDC has educational materials about basic safeguards that may want to distribute or hang up in the office.

Make sure each employee has hand sanitizer readily available, and remind them to actually use it!

Make sure each employee has disinfectant wipes easily available so they can clean their workstation at the end of each day (keyboard, phone headsets, light switches, etc.) You may also want to add regular wipe downs of things like doors and railings as a part of your routine.

Make sure employees are strictly following all clinical sanitation/cleaning protocols in accordance with existing OSHA standards. We recommend checking for any updates from OSHA on a regular basis.

Check in with janitorial staff about what they clean to fill in any gaps as needed, e.g. sanitizing door knobs and push plates on doors, cleaning the chairs in the waiting room, etc.

These may seem like you’re simply covering the basics, but for now reinforcing healthy measures is the best thing you can do.

Encourage your team to use their sick days as a strategic and preventive measure.

We know that having even one employee out of the office can put a strain on the rest of the team. But coming into work sick can result in the rest of your staff, and even your patients, getting sick as well. So while we’re in the flu season and facing the unknowns of the coronavirus, you may want to err on the safe side and encourage staff to stay home if they are getting sick, have come into contact with someone with the virus, or need to care for a sick family member.

You may have team members who try to work through their illness because they feel guilty about taking time off, or more likely, because they simply can’t afford to take unpaid days off. Be supportive of their need to take care of themselves and their families. We are monitoring to see if states will offer emergency unemployment benefits to employees affected by mandatory absences due to this illness. In the recent past, where large natural disasters have occurred, some states have enacted emergency funding for those affected.

Contingency planning

Unfortunately, despite any preventative measures you take you could still end up with a lot of sick staff or even having to shut down the office. Do yourself a favor and take some time now to plan for how you would handle that should it come up. Perhaps put together a flow chart that identifies the essential functions of each position and who would take over those functions should the primary person need to stay at home and can’t work.

If you’re thinking this is extreme, keep in mind that you never know what might happen to your business—fires, floods, hurricanes, earthquakes, tornadoes, public health issues, and more are all real things that happen to real businesses. Every business owner should have some form of a contingency plan in place so that you’re not caught completely unprepared. Your team will be looking to you for answers, and your patients and customers will be wanting to know what you’re doing.

Here are some factors to consider when creating a contingency plan for an outbreak where the office has to close or go with limited staff:

Determine essential items that need to get done, even if you are short staffed or the business is shut down. Paying bills, getting the mail, contacting vendors, patients, etc. all needs to happen. List out those tasks, and who would be responsible for each of them.

Plan for staff coverage. For example, if Team Member A is out, then Team Member B will step in to cover that department or essential tasks.

Plan for how patients will be notified if you need to reschedule appointments.

Determine what work can be done remotely, and by who, and what equipment they will need. Remember that remote employees must still follow HIPAA protocols for accessing and securing access to PHI.

We recommend a scheduled daily check in with your team. Here at CEDR we are meeting each morning with our leaders to discuss any updates, both to how we want to operate internally and how we are advising our members. If we go to a remote work situation, we will schedule daily call-ins to a conference number and check in on everyone to keep the wheels on the bus. We are currently stress testing various departments and our remote service systems because that is what makes sense for our business.

Finally, communicate to your team that you are keeping your eye on this and taking extra precautions. Encourage them to come to you with concerns, and with any ideas they may have. The goal here is to be prepared with preventative measures, and ensure your team feels supported and looked after.

What should I do if an employee requests time off because s/he thinks they may have been exposed to the virus or are feeling sick with a fever?

You and the employee may want to review the CDC’s risk assessment criteria to better evaluate the situation. If the employee is concerned they may have been exposed, but does not currently have any symptoms, then you may want to consider having the employee work remotely performing administrative tasks (if that makes sense). We do understand that clinical staff can’t see patients remotely! Additionally, if the employee is actively sick, they should not work at all.

If you have a written sick leave and/or medical leave of absence policy in place, it will make this process much easier because all you have to do is follow your policy, just like you would any other time off or leave of absence request.

To start with, give the employee the okay to go home or to not come in. If they do have a heightened risk of exposure, you don’t want to introduce that to your office. Also be sure to document every step of the way. Ask the employee to make the leave request in writing. You can have the employee provide medical certification from their medical provider of the need for leave and for how long. Approve the request in writing and make sure to establish an expected return date. If you are subject to FMLA or any similar law, make sure to use the proper documentation in compliance with those laws.

All of this can be done over email or fax rather than the employee coming into the office. Where possible, if they need more than your policy allows (they certainly will if they have the virus) be accommodating of that. When the employee reports they are able to return to work, you should ask the employee to provide certification from their medical provider that they are fit to return to work and to indicate any work restrictions.

A reminder for employers who are also medical providers:

Being a doctor doesn’t allow you to make medical decisions for your employees. You’re in the employer/manager’s seat, not the doctor’s seat in this relationship. This means that all information regarding the employee’s medical condition should come from the employee’s medical provider.

What if the office needs to close?

We certainly hope you don’t need to close your office. But if you don’t have enough healthy staff members to come in, or your patients are cancelling all their appointments, or your office has been exposed to the coronavirus, this is certainly a possibility.

If feasible and practical, employees should be authorized to work from home. Obviously healthcare providers can’t see patients this way, but at minimum you may have administrative tasks such as billing, insurance, and fielding phone calls, that can be set up remotely for a period of time. If your employees do not have experience working from home, then this will take some preparation. For this reason, we would recommend creating a remote work plan now that takes into consideration things like supplies (e.g., number of company laptops, forwarding phone calls), systems security, and a list of duties that can be performed remotely.

Having a work-from-home option also helps employees continue to have an income during a full or partial office closure. Pay your non-exempt employees for any time they spend performing work from home or going into the office to complete tasks (someone may need to pick up the mail). Your exempt employees must be paid in full for any days on which they perform work.

If the office is closed and employees are not working from home, their first question will be, “Are you going to pay us?” As usual you can make their sick/vacation/PTO time available for use. And, depending on your financial situation, it may not be a bad idea to provide some additional paid days during this type of unexpected office closure. At the very least, make sure to comply with any written office closure policy you may have.

Legally you do not need to pay a non-exempt employee when they are not working. So issuing any pay beyond accrued PTO is entirely up to you. When it comes to your exempt employees, if you are closing for part of a week you need to pay their full salary for that week. If it is a full, week-long closure, exempt employees do not need to be paid.

We encourage you to inform your staff that they can file for unemployment during a temporary work closure. There’s often concern from employers about their unemployment taxes going up from employees collecting benefits. Remember that this is insurance that you already pay for, and if there were a situation where employees should be able to get benefits from insurance this is certainly it.

 


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