FAQ #44: December 18, 2020 – Containing Answers from December 16th
Answers to Staff Questions on Employee Health and Safety, Patient Care and Clinical Questions, and HR Policies
The following FAQs were adapted from questions submitted by VNSNY staff for the CEO Conference Calls hosted by Marki Flannery on Wednesday, December 16th.
Employee Health and Safety
Q. Can you clarify which vaccine, Pfizer or Moderna, will be available for VNSNY field staff to get and how the field staff get it? And does field staff include the clinical field managers?
A. As I mentioned before, we expect the Moderna vaccine.
Andria Castellanos, Chief of Provider Services: We’re still working on our staff prioritization. And our focus initially will be on field staff who go out into the field and take care of patients. To the extent that the CFMs fall into that category, they would be included in the list of field staff. We do not expect to receive the number of vaccine doses necessary initially to give vaccine to all of our field staff. We have about 10,000 field staff in VNSNY and so we’re going to be working on a prioritization scheme. And we’ll work with the SVP to see if the CFM would fit into that category or not.
Q. What is the likely earliest date VNSNY will receive vaccine? Can it be received this week from another hospital or partner?
A. Andria Castellanos: So, the Moderna vaccine is likely to get approved this Friday. The earliest we would receive vaccine is the following Monday, the 21st. The hospitals have all received the Pfizer vaccine. We will not be administering the Pfizer vaccine. The storage requirement in a super-cooled environment is not something we can handle or manage at Visiting Nurse Service of New York. So, we will not be receiving that vaccine. So, the earliest possible date is Monday the 21st or any time after that. We really have no information on when or how much yet. So, stay tuned.
Q. I asked a question on 12/2 about the efficacy of the Rapid Test. Do we have an answer to that question? And the question was, I recently received the Abbott Lab Rapid Test on 41st Street and thankfully tested negative. Can you speak to the efficacy of the Abbott Rapid Test? Are PCR tests available as well and if not, is there a plan for PCR tests to become available for field clinicians?
A. No, we do not offer PCR tests and we do not have a plan to administer PCR tests. We do offer the Rapid Test. Dr. Dobkin, would you like to speak to the efficacy of the Rapid COVID-19 Test?
Dr. Jay Dobkin, Chief Medical Officer for VNSNY Choice Health Plans: So, the Rapid Tests we’re using that are FDA approved are not quite as sensitive as the PCR test. But in some ways, that’s a good thing because the PCR test will pick up tiny amounts of fragments of the virus often long after people have stopped being infectious. So, we think that the Rapid Test is really quite a good test to detect people who might be infectious and therefore could expose others.
Michael Bernstein, Chief Experience Officer: I just want to add that after every one of these calls as Marki mentioned, answers to the questions are posted on our Intranet. This individual said they asked the question December 12th, and the fact is that if you go to the December 12th transcript, there is a specific answer to that very question including information from Dr. Dobkin as we just heard. So, I would just encourage everybody, if we were unable to answer your question in real time during this conference call, to check the COVID site for the FAQs from that call. We want to make sure we get our accurate answers, so that we give you proper information. We do all of that work after the fact so please go to the Intranet because 99% of the time, you’re going to see a thorough answer posted there.
Q. Will the COVID-19 Home Test Kit that just received FDA approval, the Ellume COVID-19 Home Test Kit, be acceptable for a VNSNY to employee use?
A. So, I’ll mention a couple of things and then I’ll turn it over to others. VNSNY does not require employees to get tested. Clearance is needed for employees who are working in nursing homes and assisted living facilities. And in those cases, I do not know if this test will be acceptable by those facilities. They have been very strict about having a PCR test be the only test that is acceptable, and I don’t know if this home test is considered to be a PCR test.
Dr. Jay Dobkin: Yes. It’s another one of the antigen tests. My understanding is that some of the facilities are accepting the antigen test and some are not. The real issue I think is this is pretty expensive, it’s a $30 test, I believe that would be another issue.
Q. One of the side effects of the COVID-19 vaccine is Bell’s Palsy. What is the recommendation for people who have had Bell’s Palsy or who have a family history?
A. Dr. Jay Dobkin: Again, I would urge everyone when you hear about issues regarding side effects or safety for the vaccines, recognize that some of these events are as common in the placebo group as in the vaccine group, and that’s true for Bell’s Palsy. There were cases in people who got the vaccine and cases in people who were in controls. So, it’s not really clear how strongly these were associated. They could just be a coincidence. Having said that, if you’ve had Bell’s Palsy, you probably want to consult your own physician about whether to go ahead with the vaccine.
My recommendation would probably be, “Yes”. Bell’s Palsy is usually a self-limited condition that resolves. In all the years we’ve been interested in Bell’s Palsy, nobody’s really ever come up with an explanation of who gets it or why. But the good news is that it’s not dangerous and it’s not permanent. Having said that, I think if you’ve had Bell’s Palsy, you really want to consult your physician before going ahead with the vaccine.
Q. Can we go to a local hospital to get the vaccine?
A. Well, you can do what you want to do but you’re very unlikely to get the vaccine if you go to a local hospital. The priority today is for hospitals to vaccinate their healthcare workers. So, I don’t believe you’re going to have much success going to a hospital and getting a vaccine because the priority is to get the healthcare system protected. And that would be, for hospitals, to protect their own staff. Andria, do you know if there’s any different information than what I just said?
Andria Castellanos: Marki, you’re absolutely correct. The hospitals are not giving vaccine to the general public now. They are focused on immunizing and vaccinating their staff and at this point, they are only receiving vaccine for their staff. So, you would not be able to get vaccine from any of the hospitals.
Dr. Jay Dobkin: Just to add one thing: At New York Presbyterian, I think this is true at the other hospitals, the vaccine is being limited to people in very specific roles, emergency room and ICUs. So, the general staff is not even getting the vaccine yet.
Patient Care and Clinical
Q. Will parking passes be extended past December 31?
A. We are still actively working on getting these parking passes renewed. As I’ve mentioned before, the parking passes get approved through the Mayor’s Office and we’re working with the Greater New York Hospital Association to support us on that. But we always found out a couple of days before the expiration date. We’re hoping that we will get a response sooner, but we’ve been at it for a while and we continue to advocate.
Q. Can you please let me know about the availability of obtaining eFax for field staff? I asked this question about two weeks ago. I have a patient who has to complete a number of pages for an application and having eFax would save me a trip to the regional office and expedite processing the application.
A. I’ve checked in with our IT department and we have technology that is still being rolled out to staff and training needs to be completed. So, at this point it is not fully available, but it should be available soon.
Andria Castellanos: Yes, this is a Secure Fax System that we purchased to help us. We are piloting that product in Nassau and the Bronx right now and we’re going to be rolling it out to the rest of the agency in January. So, I just wanted to give that information out to everyone who’s on the call.
Q. In the beginning of the pandemic, it was very noticeable that a lot of telehealth visits were made by the day team, the COC, and social work documenting family concerns and refusing visits during COVID-19, while team managers would request an assigned visit for after-hours and weekend staff to make in-person visits for the same patients, and this is still going on.
A. I guess there’s a desire for some clarity as to why we are scheduling visits for families that are refusing them. Andria, are you able to provide any thoughts on this?
Andria Castellanos: Yes, I’m going to communicate this concern with the team. You know obviously, when we moved from weekday to weekend clearly this is a gap in communication and so we need to fix this problem. So, I’ll communicate this to the team. Thank you for bringing it to our attention.
Q. I have noticed COVID-19 alerts that were confirmed several months ago, but the patient is no longer COVID-19 positive. Has this alert been removed or grayed out, so the field staff have current updated information?
A. So, I guess this is about a patient who was COVID-19 positive several months ago, no longer positive, but still appearing positive on the alerts.
Andria Castellanos: This is another one that we’ll bring to the attention of the team. Obviously, all of these procedures have been new in the system, right? And on this one is a complicated and difficult one, so we’ll bring it to the attention of the team as well. And we’ll respond to this more directly with this team member.
Q. We have trouble leaving messages for physicians or finding the right physician and correct phone number for those who are in a hospital system, such as the VA, and some Brooklyn hospitals and clinics are sometimes difficult as well. Sometimes patients see so many physicians in the clinics that during the start of care, they’re unable to provide a name. Searching by calling the operator for a physician takes up a lot of time especially with a full schedule of patients to see. After many unsuccessful attempts to reach the physician, clinicians are instructed to reach out to the HCC and sometimes the HCCs are unable to provide the right physician information. Is there any way that someone else can reach out to the physician after the nurse has made the first of several attempts?
A. Andria Castellanos: I think this is an age-old difficult problem that we’re faced with in the Certified Home Health Agency. And after several attempts if you can’t do it and the HCC is not successful, this should go to the branch director. And the branch director will work with business development to try to find and identify the correct physician.
Everybody who works in the Certified Home Health Agency knows that if we do not have the correct physician, we cannot bill. And it is very important that we follow the correct regulations, and that we have the right orders from the right physician. So just keep going. If the HCC can’t do it, bring it to the branch director. The branch director will partner with business development and our MD Orders Group, to try to identify who the right doctor is.
Michael Bernstein: The only thing I would add is that under Andria’s leadership, this age-old problem is well understood. And it’s being examined from all perspectives to see if there are ways that we can simply improve our efficiencies getting the correct name of the doctor and the signed order. So, the question is really well stated in that paragraph and we just want to reassure everyone that it is not lost on us. That this problem, which has existed for some time, is something we really need to work on and try to come up with the best solution. So, thank you for the question.
Supplies, Masks and PPE
Q. I’m only aware of Manhattan and Queens Office to go to for supplies after hours and weekends. I do collect needed supplies for the week that are used very quickly. Foley insertion kits and catheters are a popular request especially on the afternoon shifts and unfortunately these items are never sufficient when I get the weekend supply.
A. Michael Bernstein: Sal Bastardi who oversees our supply rooms reported into me with respect to this particular question. So, all of our locations do have weekend emergency supplies. Based on the input from this question, Sal is going to ensure that we increase the inventory of both foley insertion kits and catheters. If you’re on the call and you asked this question, if there was a specific regional location you visited that would have had a shortage in weekend supplies, please email that in so we can double-down and make sure that there are enough in that location.
HR Policies / Pay and PTO Policies
Q. I’m being asked from Employee Health to send a physician letter every month for a diagnosis of health issues that are chronic. Can the accommodation request be extended to every three to six months instead of monthly?
A. Marian Haas, SVP of Human Resources: I looked into this question when I saw it this morning. We do ask that people who have requested accommodations to renew that request on a monthly basis so that we have current information that the accommodation is still needed, but there is no need to submit an MD letter every month. It’s just to acknowledge that the request is still needed. I will talk with Health Services about the frequency of that request, to see if that can be lengthened as the person is suggesting here and let you know. But thank you for the question and please be assured you do not need to submit an MD letter every month, just respond to the request.