New COVID-19 emergency standards that the federal Occupational Safety and Health Administration (OSHA) enacted last month “could harm the financial viability of many physician practices, potentially backfiring” on the Biden administration’s attempts to improve access to care, the Texas Medical Association is telling the U.S. Department of Labor.
The OSHA emergency temporary standard (ETS) took effect in full July 21 and required affected health care employers to develop and implement COVID-19 protection plans that include patient screening and management; physical distancing of at least 6 feet when feasible; physical barriers; and recordkeeping, among other requirements.
These standards are separate from the forthcoming OSHA regulations following the Biden administration's vaccination requirements for employers with 100 or more workers. Those regulations are expected in late September.
On the July rules, “Organized medicine supports pragmatic efforts by OSHA to strengthen infection control within the health care delivery system to better protect physicians, patients, and health care workers from possible exposure to the virus. That being said, while well intended, the ETS will impose new costs on physician practices at a time they can ill afford it,” TMA President E. Linda Villarreal, MD, wrote to Labor Secretary Marty Walsh in an Aug. 20 letter.
“Additionally, the ETS comes late in the public health emergency after physicians have already implemented robust infection control measures. While many of the OSHA measures mirror steps already taken, the ETS provided insufficient time for physicians to comply and also has new staffing, recordkeeping, reporting, and compliance standards that will result in new costs to outpatient physician practices.”
For example, TMA sees potential problems with OSHA’s requirement that practices with 10 or more employees provide paid time off (PTO) for the time needed to receive a COVID-19 vaccine and recover from any side effects.
“We do not object to this provision per se nor do we object to quarantining employees with known or suspected COVID-19 in accordance with CDC guidance. However, the broad definition of COVID-19 symptoms as well as the mandatory PTO could mean employees receiving this benefit unnecessarily at a huge cost,” TMA’s letter said. Even with certain caps in place, “the costs could be as high as $1,400 per week,” which “could be financially onerous to small practices and contribute to even more severe clinical staffing shortages as well as patients being referred to already overcrowded emergency departments.”
Other regulations – as detailed as ventilation and air requirements for practices who own or control buildings with existing HVAC systems – could cause physicians continue to incur significant costs at a time when the public health emergency already threatens practices’ financial viability due to months of lost revenue from practice closures and rising numbers of uninsured and related uncompensated care costs, TMA added. On top of that, “the rule has generated considerable confusion and disruption in light of already existing infection control initiatives, thus diverting physician resources from direct patient care.”
TMA’s letter urges OSHA to establish a practicing physician advisory committee in conjunction with the Centers for Disease Control and Prevention to put together infection control rules better suited for outpatient practices, and revise the rules according to that committee’s recommendations.
The OSHA rule, published June 21, was an interim final rule with request for comments, meaning it went into effect on the July 21 date but can be changed later based on comments the Department of Labor receives.