CMS waives some rules in response to COVID-19, CDC offers guidance on PPE shortages

ACP provided resources on telehealth and physician well-being, while cardiology groups advised patients to stay on angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers.


Medical organizations and government agencies continued to update their guidance on COVID-19, and ACP offered related new resources for physicians.

On March 18, CMS called for all elective surgeries and nonessential medical, surgical, and dental procedures to be postponed. The agency also recently waived some of its usual requirements, including the minimum three-day stay before admission to a skilled nursing facility, limits on the number of beds in critical access hospitals, and rules about where in hospitals acute care patients may be placed. In addition, CMS announced it would be granting exceptions and extensions in its quality reporting programs. A full list of CMS actions in response to the emergency is on the agency's website.

The CDC updated its recommendations for optimizing the supply of eye protection, isolation gowns, facemasks, and N95 respirators, including strategies for clinicians and hospitals to apply when personal protective equipment is unavailable. The FDA has also offered strategies for dealing with shortages of medical gloves and ventilators. Other recent changes to CDC guidance include new advice on when to discontinue isolation for patients recovering from COVID-19 at home. All of the agency's guidance on COVID-19 is collected on a page for health care professionals. ACP continues to press the U.S. government to do more to address COVID-19.

On March 17, cardiology experts issued a joint statement recommending that patients not discontinue angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers due to concern about the risk of more severe infection. The evidence does not indicate any increase in adverse outcomes from COVID-19 associated with these drugs, according to the statement from the American Heart Association, the Heart Failure Society of America, and the American College of Cardiology. Concerns about these drugs, as well as ibuprofen, had been raised by a research letter published by The Lancet Respiratory Medicine on March 11. The authors of the letter subsequently issued a statement clarifying that their hypothesis was intended to spur further research, not changes in treatment. On March 19, the FDA also issued a response to the research letter, saying that the agency is not aware of scientific evidence connecting the use of NSAIDs with worsening COVID-19 symptoms but is investigating the issue further.

ACP's new offerings for physicians dealing with COVID-19 include a webinar on physician well-being during the pandemic and an interactive CME program on telemedicine. Annals of Internal Medicine has also recently published several research articles about COVID-19.

In an ACP webinar on Monday, March 30, at 3 p.m. EDT, Eileen Barrett, MD, MPH, FACP, and Elisabeth Poorman, MD, will share lessons learned and best practices for both outpatient and inpatient internists. They will explore the need to acknowledge and address physician anxiety and fear of exposure to the virus, as well as provide tips for how physicians can support one another during this crisis while protecting their own well-being. Dr. Barrett is a member of ACP's Board of Regents and an ACP Well-being Champion. Dr. Poorman is an internist who also researches medical workplace safety, mental illness in medicine, and physician suicide. Participants will have the opportunity to ask questions and a discussion will continue following the webinar in ACP's COVID-19 Member Forum. This free webinar is presented jointly by the ACP Leadership Academy and the ACP Well-being and Professional Fulfillment program.

Telemedicine: A Practical Guide to Incorporation into Your Practice,” is free to ACP members and provides guidance about how to introduce and sustain a telemedicine program and deliver high-quality health care. It was developed with support from an unrestricted educational grant from Amwell.

ACP is supporting the Infectious Diseases Society of America (IDSA) on their weekly podcast series to keep members informed regarding the COVID-19 situation. Suggest topics for future podcasts in ACP's COVID-19 Member Forum. On March 19, the IDSA issued new recommendations on prioritization of testing for the virus given the limited availability of tests. ACP's COVID-19 resources for internists, including educational activities, are available on a regularly updated webpage.