Q&A log from the March 16 and 18 webinar with Dr. Claudia Sarbu, MOH
NSHA & DNS FAQs – please check against what has been shared with you over the course of the last few months
I am doing my best to follow the self-isolation, quarantine and/or social distancing guidelines and protocol from our public health office, but I want to continue providing care to my patients who need me. I don’t want to have to close my clinic or burden my colleagues who are already feeling the weight of the situation. Why can’t we use new fees to provide virtual care or change the rules for non-face-to-face billing so that we can bill for this care?
As of March 24: The virtual care fee codes have been improved. Most physicians can now bill for all non-procedural services that are delivered virtually. This means that you can bill what you normally would for an in-person visit, regardless of whether the care you deliver is done in-person or via the telephone, telehealth or any virtual care tool such as Zoom, Facetime or Skype.
The fee codes for opioid agonist therapy, psychotherapy, consultations and counselling, geriatric visits and nursing home visits are now all covered by virtual care.
Details can be found in the March 24 MSI Physician's Bulletin.
All premium fees are also applicable. This is not stated directly in the MSI Physicians’ Bulletin, but we have assurances from the Department of Health and Wellness (DHW) that premiums do apply.
For physicians for whom the 03.03x code is more remunerative than the applicable in-person fee code, you are free to bill the 03.03x consistent with the terms as outlined in the March 18, 2020 MSI Physician's Bulletin.
I’m worried about the impact to my income if I am quarantined or required to self-isolate and can’t provide care virtually. If services continue to be shut down, how will I earn an income? We should be looking at government for compensation for overhead for clinics, operating expenses, physician compensation, etc. Should I be laying off staff? What supports are coming for physicians whose business/income is impacting by these measures?
As of March 24: We continue to hear from physicians who are worried about what they can do if they are unable to work in their normal capacity during the pandemic. Some of you are already feeling the shift, with many non-essential services being cancelled. Physicians are rightly concerned about income loss, loss of clinical work, supporting their employees and maintaining business as usual. Some of you are concerned about your ability to keep your clinics open and your staff employed. Doctors Nova Scotia is having these conversations with government right now. We are talking directly to Health Minister Randy Delorey and Premier Stephen McNeil. We hope to have more information for you soon.
I have concerns about the supply of PPE available in NS.
From NSHA on March 24: Many physicians have expressed concern about a shortage of personal protective equipment (PPE). We have heard those concerns. Here’s what you need to know at this point in time:
- Supply Chain has started taking strict conservation measures to help ensure we can meet identified needs over an extended period of time. For example, stock is being distributed in quantities sufficient for one to two weeks rather than your usual supply.
- NSHA currently has enough PPE to meet demands.
- Supply Chain has been planning since January for this outbreak and have been increasing and stockpiling PPE.
- NSHA is projecting and planning for the surge in cases we know is coming. These projections are based on a number of factors, including number of expected patient encounters, settings of care, predicted number of hospitalizations, predicted length of stay, numbers of staff caring for each patient, etc. We must take steps to ensure our supply meets the coming need.
- Projections about need are based on appropriate use of PPE.
- There have been some surges in demand that cannot easily be explained. ALL requests for PPE will be evaluated on the basis of reasonableness. We cannot afford to be distributing more than is needed to meet current demand, or to be using PPE inappropriately – we will need it when there is a surge in cases.
Supply Chain is taking the following steps to increase supply of PPE:
- Working to access federal supply of PPE
- Reaching out to non-traditional international markets to import additional PPE
- Preparing additional warehouse and distribution capacity to support COVID-19 needs
A working group, co-led by Dr. Alex Mitchell and Lewis Bedford, is working to ensure a provincial approach to this work. In addition, an Emergency Innovation Team led by Gail Tomblin-Murphy, VP of Research and Innovation, is exploring possible innovative solutions to help meet the need.
We will continue to keep you updated on PPE supply as this situation develops.
What is the direction for use of Nitrous Oxide?
Infection Prevention and Control asks that use of Nitrous Oxide be prevented.
Is electroconvulsive therapy (ECT) service in mental health considered elective?
No ECT is not considered an elective procedure.
Do we have to close clinics that are in buildings attached to the hospital but not NSHA clinics?
Doctors offices can remain open, as currently this guidance is just for ambulatory clinics. We are asking doctors to pre-screen patients for COVID-19 to avoid those exhibiting symptoms presence in your offices as much as possible. If you are unable to maintain the two-metre (six feet) distancing required, you must have personal protective equipment (PPE) in accordance with droplet contact precautions. The NSHA is aware of PPE shortages and a solution is being explored.
Does a COVID-19 positive patient require an internist as the most responsible provider?
No. The most responsible provider will be decided dependent on the clinical setting and need of the patient.
Are all who may be required to be present during an aerosol generating procedure familiar with correct application and removal of PPE? Would we have enough equipment to carry out mandatory drills? Is this important enough to do in place of elective non-urgent ORs?
There are resources on the NSHA’s physician site with donning and doffing PPE.
NSHA Procurement is looking after supplies and there is enough PPE currently, but they are asking everyone to leave stock in place until needed. Re-stocking is taking place throughout the week.
The NSHA is not recommending using PPE for drills at this time to conserve for when needed most.
Equipment: Where is PPE kept and who is responsible for ensuring stock?
Personal protective equipment is kept in the usual supply areas in each site. The NSHA provincial supply chain group are part of the emergency operations centre (EOC) and they are ensuring adequate stock.
Are health-care workers with family members or roommates self-isolating after returning from outside country required to self-isolate if they didn’t travel?
Not at the current time. Please ensure your family member is monitoring symptoms regularly and if they exhibit symptoms be sure to notify Occupational Health and Safety Wellness Line immediately: 1-833-750-0632.
The NSHA is asking all staff and physicians to not call 811 and to not present at Coronavirus Assessment Centres.
Will we be able to start moving long-term care (LTC) patients out of our facilities as we plan for surge?
Site teams around the province are working on business continuity plans and this involves moving all patients within the realm of what is possible and safe.
Why aren’t we screening patients who are travelling within Canada and are coming from sites with higher incidence of COVID-19?
Current public health guidelines are not calling for this screening as there is low evidence of community spread in Canada. As information is evolving, this directive may change and the NSHA will keep you up to date.
Is there a resource for patient self-screening for COVID-19?
Self-screening guidelines are available on 811 website.
What is the difference between self-isolation and quarantine?
All NSHA staff and medical staff arriving from out of country travel after March 13, 12 noon, are required to self-isolate for 14 days.
Isolation refers to an individual with symptoms and quarantine refers to exclusions in persons without symptoms. However, the mainstream use in the current context has meshed these two terms.
The goal of quarantine is to prevent any transmission if one becomes minimally symptomatic. The measures listed under self-isolation on the Public Health Agency of Canada website would be considered the “gold standard” to prevent transmission. Practically, the full extent of these measures may be unrealistic for the asymptomatic returning traveler. The DHW resource is a more practical example, where the asymptomatic returning traveller would stay in their own home, avoid visitors and avoid close contact with vulnerable people.
This can be further complicated for health providers who are returning from travel outside the country and have to consider their partners, spouses or other housemates. The best advice would be to self-isolate from other members of the same home (or at a separate location if possible) or ask those members to self-isolate or work from home and avoid contact with others as much as possible during the 14-day period as well.
To appropriately self-isolate:
- Avoid close contact with people with chronic conditions, compromised immune systems and older adults.
- Don’t have visitors to your home.
- Avoid situations like social gatherings, work, school, daycare or visiting other people who are in a health-care facility or long-term care residence.
- Limit taking public transit, taxis and ride sharing.
- Wash your hands often with soap and warm water, for at least 20 seconds. Use hand sanitizer if soap and water are not available.
- Cover your mouth and nose with your arm when coughing or sneezing.
- The Government of Canada has additional resources about how to self isolate and how to care for someone with COVID-19.
This is a helpful article on social distancing.
Why can’t physicians returning from travel just be swabbed/screened and then return to work sooner than the 14-day advisory?
This is a provincial guideline, similar to other jurisdictions in Canada. Although the incubation period is on average five days, there are cases that have presented later so swabbing on arrival cannot predict who might be incubating infection and present at a later date that could lead to exposure of others. The NSHA is taking all measures to prevent potential exposure to patients who may be a higher risk of complications and care providers who are crucial to our provincial response.
I’m a doctor and I’ve travelled outside Canada and am now symptomatic. What do I do?
Leave the workplace, self-isolate and call the Occupational Health and Safety Line to discuss: 1-833-750-0632.
The NSHA is asking all staff and physicians to not call 811 and to not present at Coronavirus Assessment Centres.
Does our DNS benefits cover me for lost time due to self-isolation, etc.?
Doctors Nova Scotia benefits with Canada Life (formerly Great-West Life) cover health and dental only. A notice previously posted by Canada Life about short-term disability is not applicable to members. To the 1,600 members who have private disability insurance through OMA, your coverage has at least a 30-day (and in most cases a 60-day) waiting period. If you have coverage through other plans, please consult your plan providers about things like waiting periods and eligibility for quarantine versus illness.
I need help, personally or professionally, getting through this crisis.
Please contact the DNS Professional Support Program for CONFIDENTIAL help 24-7, 365 days a year. Call 902-468-8215 or 1-855-275-8215 (toll-free) or email email@example.com.
I’ve heard DNS has cancelled all meetings and events. What about….
- All Board of Director meetings, E-health Committee meetings, section meetings or other meetings scheduled between March 18 and June 30 will be conducted virtually, supported by the GoToMeeting or GoToWebinar platform.
- Physician Leadership Institute (PLI) and the Section of Physician Leader activities scheduled for April and May are cancelled. If you’ve registered for PLI courses, you will receive a full refund from DNS by the end of March 2020. If you’ve made a hotel reservation, please cancel that as soon as possible.
- DNS’s annual conference at Digby Pines Golf Resort and Spa is postponed to October 2020.
- If you’ve already registered, you will receive a full refund.
- If you’ve made a hotel reservation, please cancel that as soon as possible. (Digby Pines has pushed their opening day to June 19, 2020)
- Doctors Nova Scotia staff will not be visiting physicians in clinics and hospital facilities on Doctors Day. We will send you some uplifting messages from your patients, via DNS email, on May 1 to help lift your spirits during this difficult time.
If you have any questions about an upcoming meeting with DNS, please contact the meeting organizer for more details.
Why have you cancelled all meetings and events?
To ensure we’re respecting the protocol for social distancing and in recognition doctors need to focus on their patients and when they have some down time, on their families. While some meetings are cancelled, we will postpone or move to a virtual platform many upcoming events and meetings that were planned to take place over the next three months.
Our decisions were guided by Public Health’s Matrix for Risk-Informed Decision-Making for Mass Gathering and considered our business continuity planning.
How has DNS prepared for COVID-19? Is the office closed?
To be cautious and responsible, as of March 18 all employees will work from home, consistent with our business continuity plan and measures that many public institutions are taking to facilitate social distancing.
Instead of visiting our office, please reach us by phone or email. For physicians who have upcoming meetings scheduled, staff will be in touch to offer alternative ways to participate in meetings.
Our main line will be closely monitored during regular business hours. If you call, please leave a message and someone will get back to you as soon as possible.
Questions can be directed to firstname.lastname@example.org.
Local Medical Officer of Health contact information
Inquiries from DNS can be directed to email@example.com