As medical provider response to COVID-19 continues to change rapidly, Paradigm Specialty Networks (PSN) will update our clients accordingly on our operational experience and daily communications with the provider community.

Patient Safety

Patient safety and concern is of utmost importance. Our orthopedic, pain management and post-acute care providers are taking multiple precautions, including implementing triage processes prior to visits to identify signs of illness, as well as restricting guests from accompanying patients when not out of necessity. The following additional safety guidelines are in place with our provider groups:

• Pre-Screening: Clinical staff are screened before entering the building; patients must sanitize their hands upon entry.
• Remote Check-In and Spacing: Patient’s cell is called when appointment room is ready, cutting waiting room traffic.
• Isolation Rooms: If a patient is feeling ill but still needs to be seen, our providers use isolation rooms where the patient and all healthcare providers will be gloved and masked. The room is sanitized pre- and post-appointment.
• Telemedicine: When appropriate, providers offer telehealth for evaluation and management of current patients. Providers must document consent, and PSN will coordinate among all parties if the telemedicine visit is authorized.
• Post-Acute Care Facilities: Our network facilities have an ongoing institutional infection control program, using:

• • Enhanced sanitation/cleaning activities
  • Enhanced body and surface contact isolation practices (including patient isolation)
  • Visitor restrictions to the facility
  • Specific treatment therapies for infected patients, and prophylactic treatment for non-infected patients
  • Widespread patient/visitor/staff education

Scheduling Update

Since our last release, we have found that a great percentage (upwards of 90%+) of our in-network providers remain open and are actively scheduling orthopedic exams and essential surgeries.

• Physician Appointments: We continue to secure and schedule evaluation and follow-up appointments. However, these appointments are being scheduled farther out due to reduced hours of provider operation. Our current appointment scheduling time stands at 8 business days from receipt of the referral.
•  Surgery: The Centers for Medicare & Medicaid Services (CMS) recently issued a press release guiding orthopedic surgeons to postpone elective surgeries. Factors that impact whether a surgery could be postponed include:

• • Patient risk factors (age, risk of infection, and whether the patient will be significantly worse off due to delay)
  • Availability of beds, staff and PPE in the geographic area of service
  • Urgency of the procedure

CMS also provides a “three-tiered” approach in evaluating procedure urgency, which remains the provider’s responsibility:

1. Tier One is to postpone the surgery (ex: carpal tunnel release).
2. Tier Two is to consider postponing the surgery. Most of the orthopedic surgeries that PSN manages for our clients fall into this category, specifically shoulder and knee repair and work-related spinal surgery. It is imperative that the provider evaluates the need for surgery so as not to exacerbate the injury or impair long-term recovery.
3. Tier Three involves essential surgeries that should not be postponed. Examples include trauma and life-threatening limb and vascular surgery.

We will continue to work with our providers and patients in rescheduling any surgeries deemed non-emergent, and keep the claims examiner and nurse case manager apprised of patient status. Please know that we are working diligently to secure surgery dates, even if they are farther out, to ensure that the patient has a future appointment on the books.

Paradigm Specialty Networks is committed to helping guide our providers and injured workers to recovery as we navigate these challenging circumstances together. We welcome your follow-up questions, feedback, and suggestions by contacting referrals-networks@paradigmcorp.com.