COVID-19 Surge Staffing and Capacity FAQs

Where can I find more information about Vizient?

Visit Vizient’s website for additional information.

What are the requirements to qualify for Vizient assistance? 

The Vizient-Missouri state partnership is a strategy to increase bed capacity throughout Missouri. Hospitals were identified based on the ability to open closed units or add beds within seven days. This information was gathered from hospitals on Nov. 12 through EMResource, with engagement from emergency preparedness and human resource leaders from 116 hospitals.  

How does this program work?  

This program was designed to rapidly and efficiently increase surge capacity throughout Missouri. Modifying arenas, hotels and shuttered hospitals have resulted in high costs, extensive time for renovation, liability and management challenges, and limited patient types to be treated in these alternate care sites. Expanding capacity in functional hospitals is a flexible, faster and cost-efficient model that can be expanded in many, rather than one or two, communities.   

What are the obligations for the state of Missouri and participating hospitals?  

The state of Missouri and Vizient signed a master services agreement and, based on bed expansion capability, are working with hospitals to determine core staffing needed to support this expansion. The state will support the first phase of this project, approximately the first four weeks of staffing. The hospitals will be required to pay for the remainder of the 12-week staffing contracts.  

What is the timeline? 

The process currently is underway. The goal is to have staff begin in Missouri as soon as recruitment and administrative work is complete. The program is a 12-week staffing plan designed to alleviate strain through the winter surge.  

How will this program help all hospitals?  

The rural and metropolitan hospitals participating in this program understand their responsibility to decompress patient surge in their region and throughout the state. If fully staffed, this program will increase beds by more than 500 in Missouri, thus alleviating strain in many communities.  

Will the list of hospitals receiving staff be released? 

Gov. Parson released the names of all hospitals identified for initial planning. The final list of participating hospitals is not yet final.  

Do you know if other states have contracted with this vendor? 

Yes, many other states have used Vizient to address staff shortages and patient surge. Vizient supported surge efforts in Maryland, Arizona, Texas and Illinois.  

What are the financial arrangements to pay for this assistance? Will the CARES Act funds be extended past Dec. 31, 2020? 

The governor has committed to paying for the first phase of this program beyond Dec. 31.  

Can Vizient begin recruiting our employees to go to work for them?  

Vizient recruitment prohibits staff currently working in any Missouri health care facility, including long-term care, home health, etc., from accepting a contract. Language has been requested to ensure this criterion includes Kansas City and St. Louis metropolitan areas. In addition to other screening methods, agency staff will be required to sign a cover attestation and submit past and current places of employment.  

What happens to my current travel nurses if the Vizient rates are higher? 

The current rates for agency staff, especially critical care nurses, are very high and rising based on national demand. Vizient has taken several steps, including not over-recruiting and setting Midwest versus coastal rates, to remain within the range currently being asked.

How long will credentialing take, and how long will it take to get the nurses onboarded? 

The process is moving quickly, although credentialing and background checks still must be required.  

Will Vizient supply staff for long-term care facilities? 

Currently, there is no plan for Vizient to supply staff for LTCFs. LTCFs will continue working with DMAT for targeted staffing needs when a facility is at risk for closure due to lack of staffing.  

Hospital and LTCF Communication

How can hospitals improve communication with LTCFs on a patient’s COVID-19 status? 

MHA, in collaboration with the Missouri Health Care Association and Leading Age Missouri, developed the Hospital to Facility Transfer Form. The form reflects the latest guidance for consideration when transferring a patient from the inpatient setting to that of a long-term or skilled environment outside the hospital. The document clearly communicates a patient’s COVID-19 status and informs the facility on considerations for care of the patient. The facility should receive a copy of the form. The following video explains how to use the form. 

Why was the Long-Term Care Bed Availability Portal developed? 

MHA, Missouri Health Care Association and Leading Age Missouri members asked to have a way to easily communicate bed availability among hospitals and facilities. Hospitals voiced the need to easily identify facilities that were able to take admissions. The associations worked with the Missouri Department of Health and Senior Services to develop a long-term care bed availability portal. 

Are LTCFs required to report their bed availability? 

No. This is a voluntary process. Certainly, hospitals can encourage facilities to report their information to improve coordination communication, but DHSS is not going to require facilities to report. 

When will the dashboard be available? 

The dashboard became available on Nov. 25, and facilities were emailed a survey link to provide their facility’s information. The information immediately began to populate the dashboard and be available to hospitals.  

How often is the dashboard updated? 

All facilities are asked to update their information daily by 9 a.m. However, if a facility updates information after 9 a.m., the dashboard immediately will reflect that update. 

Who should the hospital contact if there are data problems with the dashboard?  

Questions with the technology should be sent to Holly Withrow at Holly.Withrow@oa.mo.gov. Other questions or feedback specifically related to hospitals can be sent to Sarah Willson at swillson@mhanet.com, or Kara Amann-Kale at kamann-kale@mhanet.com. 

Where can the dashboard be accessed? 

https://mophep.maps.arcgis.com/apps/opsdashboard/index.html#/f1e0745f93fe46b482d8ff4585f821bf 

Are there instructions on how to export the data? 

Yes. Click on ‘Instructions’ under the map for information about how to use the dashboard. 

Do hospital staff need a special login to access the dashboard site? 

No. Just launch the dashboard whenever seeking additional information.

Can we access information by region? 

Yes. The functionality of the site is based on zooming in and out of the map. To see statewide data on the dashboard, ensure the whole map is visible. To look at a specific region, zoom in on the desired region. The data on the dashboard updates while zooming in and out of the map. Users also can use the “Export Tool” to identify a particular facility, location or region, as well as to export data that can then be sorted and used to inform hospital operations. 

Why aren’t all LTCFs listed on the map? 

The submission of data is a voluntary process. A facility may choose to not submit data for a variety of reasons. If they do not submit data, their information does not exist. A facility can choose to participate on a daily basis and join in with data submission at whatever point they choose.  

Is the information on the dashboard a true reflection of statewide bed availability in facilities?  

No. As mentioned, submission of information is on a voluntary basis and will not reflect a true statewide number of available facility beds. In addition, census and staffing in facilities is a fluid process, as it is in hospitals. Just because a facility has a number of beds marked as available does not mean that is the actual number available, or that they have the capacity to accept the patient. The dashboard is a tool to help hospitals locate an accepting facility faster. All normal care management processes remain in effect for the agreement of acceptance of a patient into a facility. 

In addition to the public/private partnership with Vizient and the state of Missouri, what other options are available to assist hospitals in the recruitment of clinical staff? 

MHA and its subsidiary, APS, have an existing staffing arrangement with APS Staffing/Qualivis. Many Missouri facilities already are using or are in the process of filling surge staff needs with them. Contact Jan O’Brien at jan.obrien@qualivis.com or Jen McHugh at jen.mchugh@qualivis.com for assistance. 

What other actions are the governor and state agencies taking to manage the strain on the health care system?  

The Missouri Disaster Medical Assistance Team and Missouri National Guard are staffed by clinicians and leaders from Missouri health care facilities. These teams are assigned to short-term missions to alleviate severe stress in a specific health care facility. They have been assigned to long-term care facilities with large outbreaks, assigned to veterans’ homes, supported community testing, and have been deployed to a few small hospitals for short assignments when staffing was critically low, often due to an outbreak.  

Who determines where DMAT teams are placed?  

The Missouri State Emergency Management Agency and the Missouri Department of Health and Senior Services evaluate and approve or reject any request for DMAT.  

The Centers for Medicare & Medicaid Services announced new steps to care for patients outside a traditional hospital setting given the rising number of COVID-19 hospitalizations throughout the country. Individual hospitals can apply for a waiver of §482.23(b) and (b)(1) of the Hospital Conditions of Participation, which require nursing services to be provided on premises 24 hours a day, 7 days a week and the immediate availability of a registered nurse for care of any patient. CMS compiled FAQs for hospitals that may be interested in obtaining an Acute Hospital Care At Home waiver. 

What resources are available to organizations interested in treating acute hospital care at home patients? 

• CMS compiled FAQs for hospitals that may be interested in obtaining an Acute Hospital Care At Home waiver. 
• Questions: AcuteHospitalCareAtHome@cms.hhs.gov. 
• Hospital at Home consulting group through Johns Hopkins Medicine: http://www.hospitalathome.org/develop-your-program/toolkit.php  
• Example of published Inclusion and Exclusion Criteria: Levine, D.M., Ouchi, K., Blanchfield, B, et al. (2020). Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Annals of Internal Medicine, 172(2),77-85. Available at https://www.acpjournals.org/doi/pdf/10.7326/M19-0600    

What kind of conditions may be treated in the patient’s home? 

CMS believes that treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease, can be treated appropriately and safely in home settings with proper monitoring and treatment protocols. 

Has any hospital tried providing acute services in a patient’s home? 

Six health systems with extensive experience providing acute hospital care at home already have been approved for the new waivers and include Brigham and Women’s Hospital (Massachusetts); Huntsman Cancer Institute (Utah); Massachusetts General Hospital (Massachusetts); Mount Sinai Health System (New York City); Presbyterian Healthcare Services (New Mexico); and UnityPoint Health (Iowa).  

What is the difference between Hospital At Home and Home Health? 

The program clearly differentiates the delivery of acute hospital care at home from more traditional home health services. While home health care provides important skilled nursing and other skilled care services, Acute Hospital Care at Home is for beneficiaries who require acute inpatient admission to a hospital and who require at least daily rounding by a physician and a medical team monitoring their care needs on an ongoing basis. 

Is the Hospital At Home waiver a blanket waiver? 

No. Individual hospitals can apply for a waiver of §482.23(b) and (b)(1) of the Hospital Conditions of Participation, which require nursing services to be provided on premises 24 hours a day, 7 days a week and the immediate availability of a registered nurse for care of any patient. 

Does the patient have to come to the hospital before being admitted at home? 

Yes. Beneficiaries only will be admitted from emergency departments and inpatient hospital beds, and an in-person physician evaluation is required before beginning care at home. An R.N. will evaluate each patient once daily either in person or remotely, and two in-person visits will occur daily by either R.N.s or mobile integrated health paramedics (Community Paramedic), based on the patient’s nursing plan and hospital policies. 

How would a hospital bill for at home inpatient services? 

There are a lot of questions looming about how hospitals can get paid when providing acute care in the patient’s home. Please reach out to Andrew Wheeler at awheeler@mhanet.com with additional questions.