November 20 Employee Huddle

November 20, 2020

Please Note: When time does not allow us to answer every submitted question, we answer questions at the next week KD Huddle. Submit a question now for next week by e-mailing dvolosin@kaweahhealth.org.

Questions and Answers from the November 20 Kaweah Health Employee Huddle

What is the hospital’s guidance around department potlucks for the holidays?

With the incidences of COVID increasing, we do not want any departments holding potlucks. Departments may provide individually wrapped foods but while masks are off to eat, maintain physical distancing. We know this will be challenging in some of our small lounges, but please stay safe. We have seen a large increase in positive employees this week – about 15.

What is the current number of COVID-19 positive employees?

43 on Monday to 54 on Thursday. New cases believed to have been from personal and community spread.

Can you please clarify in detail what is considered Supplemental COVID PSL and what is not?

The Supplemental pay is paid up to the daily limits and/or 80 hours while believing to be symptomatic or exposed and pending the COVID test. Once the test is confirmed positive, the pay continues. If the test is negative, the pay ends and PTO/PSL is applied or PTO. Employee Health no longer “clears” employees after they have a negative test, even if they have symptoms of illness. As in the past (before COVID), it is up to the employee to determine if they can work without being contagious of illness to others. A flyer went out yesterday about this.

There are still a lot of mixed messages regarding the rapid testing being
offered at the Rural Clinics. Was there a change in policy for testing?

Historically, we did not have the testing capacity to test asymptomatic people. With the addition of the rapid testing devices throughout our clinic system, we were able to expand testing for the community. This, however, did not change the workflow. Symptomatic or not, all lab orders still require a providers order so that the patient can be contacted if the result is positive to provide appropriate follow-up care.

What have we done to improve accessibility for these hotlines to encourage testing?

As we received the point-of-care devices we installed them incrementally throughout the clinic network starting with VMC and our rural health clinics and most recently our urgent care locations. We started our COVID hotline which historically was meeting the community appropriately until last week when we experienced an exponential increase in calls from the community. At one point our COVID hotline was testing about ~12-15 patients/day… on Monday we received over 2,000 calls before noon. We are in the process of adding more staff and providers to meet this need, but this takes a little time. We have, however, added COVID testing capabilities to our Court St Urgent Care location as of Monday which is open 7 days/week and 14 hours a day, as well as our Urgent Care location on Demaree. This expansion in testing locations, days and hours of service will help increase access in the immediate term while we work in parallel tracks to add resources to the hotline and other locations

Are people being denied testing now due to lack of correlating symptoms?

No, no one should be denied testing.

Who do they contact if they are being denied testing?

Ivan Jara or Jessica Rodriguez

All other centers are currently charging out of pocket costs, including Quick Care for testing; which is discouraging the community. Why are we not charging?

The RHCs and KD Urgent Cares are on Kaweah Health’s public hospital license and we are not balance billing the patients for COVID testing due to receipt of CARES act funding.

There is a genuine concern in the lack of consistent information, even when the proper channels are contacted for clarification.

We are working with our clinic operations, marketing and media relations to improve our consistency. With ever changing regulations, mandates and expectations from the State and Federal government, supply chain disruption, staff and provider shortages it has been a significant to standardize workflows and messaging. We appreciate the communities support and patience as we grapple with the day-in-day-out issues caused by the COVID pandemic. Please know we’re working around the clock to better serve our community.

If you don’t have a provider order can you go to the clinic and have the provider do the order from there?

Yes, they could. And there will be a cost for the visit for the physician order.

Is there a limit to the number of times for an employee to get COVID-19 supplemental funds?

The maximum for a full time employee is 80 hours. There are maximums on supplemental pay that was issued through the law. We have 55 employees that are out right now so many are receiving that supplemental pay. If you have questions on the limits contact the LOA team.

When do you think KD will receive the vaccine?

It is not known for sure the amount of drug being allocated to the State of California and from which Manufacture but we are expecting to likely receive some vaccine the middle to end of December. There is daily information we assess and review from the state and federal government on the vaccine and are working with folks to develop a list of highest risk employees who will receive the vaccine first based on what amount of drug we receive.

Can a college student coming home for the holiday’s get tested?

Yes, a lot of students are also getting tested before they come home if they are living on the campus or adjacent to the campus.

Does KD have a policy on employees traveling for the holidays?

There is a governor mandated curfew from 10pm to 5am but there is no travel quarantine as of right now for traveling out of state. Our recommendation is for our employees to stay home and not travel over the holiday season.

Are we going to start testing TCS employees twice a week?

We are mandated by CDPH to test our SNF staff at least once a week, regardless of status of COVID-19 infections in the facility or County. In addition, CMS mandates that we increase that testing to twice weekly if the positivity rate in the County goes above 10%.

The information that has been put out about the visitor policy at Skilled Nursing
is incorrect. Can you tell everybody what it is?

It was brought to our attention that we have mixed messages posted about this facility. The correct information is as follows: Visitation to patients in Subacute units and Transitional Care located at our South Campus (1633 S. Court Street) is allowed for 30 minute visits that must be scheduled in advance. Up to 2 visitors from the same household may visit per patient. Visits will take place either outdoors or in a large communal space such as a dining room or activity room, not in the patient room. All visitors must wear a mask and will be screened for symptoms upon entrance to the building. A staff member will supervise each visit to ensure proper mask use and social distancing. Visitation days are dependent upon the staff availability and may vary at each campus.

Now that our numbers are going up again….

Are we going to shut down the facility for visitors?

We are watching the numbers closely and having active discussions with command center leaders regarding the visitor policy. We may have to consider going back to a no visitor policy if the numbers continue to go up. CDPH recommends no visitors when the County is in the purple tier. Still, we decided to bring back one visitor because of the importance the family plays in communication and the patient's recovery.

Are we going to shut down non-emergent surgeries?

Not as of now. We are watching the inpatient census closely. If we have a surge like the one we had in the summer and need the inpatient beds for COVID and general medical patients, we may have to consider limiting non-emergent surgeries. We are meeting twice a week to review bed capacity and surgical volumes.

Are we going to be limiting our surgeries?

As of right now we are not. We are going to do everything in our power to keep surgeries going.

Does the State or Kaweah Health make the decision to shut down surgeries?

The decision is made on both fronts. It can be mandated from the State through the County to stop surgeries to keep beds open. There can be emergent cases. Those decisions will be looked at closely when it becomes more serious. Fingers crossed it will happen.

Are other local hospitals also halting merit increases?

Yes, we learned yesterday that Adventist Health in Tulare and Hanford have frozen wages and we believe Saint Agnes in Fresno has as well. It is the last thing in an organization that we want to do.

Why can’t we open up The Lifestyle Center for personal training and put it under the rehabilitation umbrella? Some people’s health is at risk due to their not being able to exercise.

We have had discussions both at the Executive level and at the command center regarding similar scenarios as mentioned above. At this point, since the County is in the Purple tier, we are following the State guidelines, which states that indoor gyms need to remain closed.

Why can we offer Cryotherapy?

It is one on one and reserved for injuries. Everyone felt comfortable with it and continue down that path.

There is a lot of concern about Stanford being out of network as a lot of our employees have doctors there and have built a relationship with that facility. It has been stated that people who already have the history with Stanford will have an exception. What does that mean in terms of cost?

The employee benefit package effective 1/1/21 did not exclude Stanford as a provider. They are covered as In-Network, with a deductible and coinsurance. The Foundation for Medical Care has verified that we really only have about four members with continuing care there. Where the confusion may lie is that we have negotiated a better contract with USC. Using their services will very likely result in less out of pocket expense overall for a member as our contract rates are lower. We encourage you to “shop” in-network services before you decide where to go.

Is a list of contracted providers in that handout or separate?

The provider list is on page 30 in the Benefits Guidebook.

Does our employee pharmacy do 90-day supplies for maintenance prescriptions?

We will provide 90-day supply for maintenance prescriptions. This is true now and with the new health plans.

Is the HSA seed money for high deductible plan guaranteed or at the discretion of KD based on the financial situation?

Your HSA is guaranteed.

What did the October Financials look like? Are the executives concerned and should the employees be worried about further layoffs or cuts?

We are four months into the fiscal year. I am normally not excited to see numbers in red, but when they keep getting smaller and smaller it does make me feel better. That is certainly the case for October. We have an operating loss of $2.3 million which is the smallest this fiscal year. For revenue, we had budgeted $52 million for the month and we brought in $51 million. It is reflective of bringing back all elective surgery and being an incredibly busy hospital. Malinda Tupper was reporting that we are still seeing outpatient volume lower than what we typically see. On a very positive note, we received $4.5 million dollars in federal stimulus funds in the month of October and additional funds from our County to help with testing and pharmaceutical expenses. After taking these stimulus and support funds into consideration, we ended up “in the black” by $2.2 million.

Does the County listen to KD? There seems to be a disconnect in what each organization is saying.

I would say it has been a fluid process as we were not on the same page at the beginning of the pandemic. We have done several unified messages with the County and even had some combined press conferences. If anyone is aware of conflicting messaging, please reach out to us.