As the nation’s hospitals struggle with a continuing shortage of personal protective equipment (PPE), the American Medical Association (AMA) has asked the Trump administration to use the Defense Production Act (DPA) to generate an adequate supply of PPE for physicians in all settings, including ambulatory care offices.
In a June 30 letter to Vice President Mike Pence, who heads the White House Coronavirus Task Force, AMA Executive Vice President James Madara, MD, noted that physician practices are now reopening across the country after having scaled back non-emergent medical services and procedures in late March to slow the spread of the COVID-19 pandemic. Particularly because many patients have delayed obtaining necessary medical services, Madara said, it is critical for ambulatory care physicians to get back to work as soon as possible.
The biggest challenge to reopening practices, physicians have told the AMA, “is the ongoing shortages of PPE, especially N95 masks and gowns,” the letter noted. Because physicians had not previously needed this gear, the AMA explained, they had no existing relationships with PPE vendors or the ability to source these items.
Also, because ambulatory care practices require much smaller quantities of masks and gowns than hospitals and other facilities do, these institutions have more bargaining power to obtain these essential supplies. As a result, physician practices are getting squeezed out in many cases.
“Without adequate PPE, physician practices may have to continue deferring care or remaining closed, which will continue to have a dramatic impact on the health of their patients,” the AMA letter warned. “Furthermore, the ability to access PPE will help determine the future viability of physician practices.”
The letter cited research showing that physician practice revenue decreased at least 50% between March and May, which translates to a $70.6 billion drop in volume.
“For the sake of our patients’ health and to ensure we do not drastically reduce the number of sites available to provide healthcare services, we need to make sure practices remain open and able to provide care,” the AMA pointed out, adding that delayed care will result in sicker patients and unnecessary hospitalizations.
The AMA concluded by saying it “now believes the PPE in ambulatory settings is so challenging that the only way to address it is for the administration to use the Defense Production Act” to procure the necessary N95 masks and gowns.
Request to FEMA
In an AMA letter to FEMA Administrator Peter Gaynor, Madara expressed the same concerns about the availability of PPE for clinicians in office-based settings. Supplies of PPE and disinfectants are scarce, and “the sources that are available are reportedly fulfilling only very large institution-sized orders,” the letter said. “We are hearing significant and growing concern from our member physicians that they cannot secure needed supplies to safely reopen…”
A significant obstacle to devising solutions has been a lack of data on whether the problem lies in the availability of raw materials, production backlogs, gaps in distribution, or some combination of these factors, Madara noted.
A recent administration report to the Senate Homeland Security Committee provided information about the PPE supply situation for hospitals, other institutions, first responders, and non-health care staff such as janitors, the letter stated, “but no information was provided on access for ambulatory care sites such as physician offices.”
“We urge FEMA to work with us to provide additional assistance to these non-hospital physicians in securing PPE, disinfectants and sanitizers,” the letter states.
Among other things, the AMA suggested, FEMA should provide guidance to physicians across the country on where they might be able to obtain these items from legitimate manufacturers or suppliers. A clearinghouse might be created on a regional, state or local level to supply this information to healthcare providers, the letter said.
The AMA has been warning since early June that as practices reopened, they were being hampered by the shortage of PPE. In a June 5 letter to Pence, Madara said, “While it is critical to the long-term viability of these practices to return to seeing patients in person, the serious threat of COVID-19 infection persists, and it is essential that physicians and their staff institute proper infection-control procedures in their practices.”
Meanwhile, serious PPE shortages persist in hospitals. A June 17 Vox article noted that, while the infection rate was rising in 21 states, supplies of masks and gowns were perilously low in many areas, according to government and media reports. An internal FEMA report said the government planned to continue asking medical staff to reuse N95 masks and surgical gowns intended to be disposed of after one use.