State Regulatory Waivers That Helped Hospitals, Health Care Providers During Pandemic Set To Expire

Published September 16, 2021 at 9:15 AM EDT

🎧 LISTEN • 22:30

📸: Jae C. Hong / AP

On today’s program: We hear how waivers that provided more flexibility and eased administrative burdens helped medical facilities face the pandemic, but they’re set to expire later this month; an obstetrician-gynecologist explains why a new bereavement leave policy for city employees will help those facing pregnancy loss; and a conversation about the increasing mental health needs of children and teenagers in the pandemic.

Medical waivers that lowered administrative barriers for health care workers set to expire (0:00 - 8:14)

Last year in the early weeks and months of the pandemic, hospitals and health care providers were swamped with patients who contracted COVID-19. Gov. Tom Wolf approved waivers to keep medical workers on the job and help bring in others, but those waivers are set to expire on Sept. 30.

“They were supposed to give a little bit of flexibility to people … [whose] jobs were upended or they were on the frontlines of fighting COVID,” says Danielle Ohl, a reporter with Spotlight PA.

One example of how these waivers worked is nurses or doctors with lapsed licenses could return to work in facilities, removing some administrative barriers.

Nearly 100 such waivers were implemented, however, Ohl says there isn’t good data on how many people used them.

Should the waivers not be extended, Ohl says boards that govern professions with waivers will be overwhelmed.

“In the most dire case, a nurse could be pulled off the floor because their paperwork didn’t go through or it expired,” says Ohl. “There is just a fear that the administrative burden isn’t going to be dealt with and they don’t really know what that means, and they don’t want to take a chance in breaking the law.”

Ohl says the legislature could extend the waivers, but it’s unclear if that will happen while the legislature is currently out of session.

PANA Members Recount How Patients and Facilities Benefit from Waiver Removing Physician Supervision

Health-care facilities, patients benefit from waiver removing physician supervision during pandemic

We shared with you previously stories from the frontline among certified registered nurse anesthetists who are experiencing firsthand the effects of the state’s temporary blanket waiver removing the physician supervision requirement for CRNAs.

The waiver was included in an executive order that the governor signed to protect health-care practitioners for good-faith actions taken in response to this crisis, and it remains in effect for the duration of the governor’s disaster proclamation.

As you know, Pennsylvania regulations still require physician supervision of CRNAs in a hospital setting. The temporary suspension gives health-care facilities more flexibility to tap into the unique skillset of CRNAs to fulfill critical roles outside the operating room during this crisis. After all, CRNAs possess a skillset uniquely suited to aid during a respiratory pandemic.

Without a doubt, the waiver has made a real difference. Here are some more voices from the frontline. (Please note that the names of the CRNAs and their facilities have been removed to ensure their anonymity and protection in the workplace.)

“My hospital may not financially survive since elective procedures have been canceled. Our anesthesia team staffing had to change to preserve costs and the governor’s order helped us accomplish that.”

“Our role has been authorized for this expansion of function outside the operating room. The plan is to utilize CRNAs to run overflow ICU beds in our PACU and pre-op areas. CRNAs would manage patient care, manage ventilators, order labs, medications and appropriate radiology studies, and insert central and arterial lines as needed.”

“In our facility, CRNAs served in the OR, in labor and delivery, and on the intubation team for the ED and COVID/PUI patients; we also had a portion of our team train to perform supportive roles in our critical care units and also make the PACU into a makeshift ICU if the need arose but that has not been necessary as of this point.”

“Hospital administration along with the support of our MD Anesthesiologist (MDA) counterparts also suspended MDA supervision at the hospital, allowing the CRNAs to practice to the full extent of our knowledge and training. The CRNAs performed advanced practice skills and critical care decisions independent of the anesthesiologists. CRNAs were also the sole advanced practice provider at night during the first two weeks of the COVID crisis. For five weeks, the CRNAs put into practice the skills and knowledge to assist the ICU physicians, nurse practitioners, and nurses. The CRNAs knowingly put themselves literally face to face with COVID patients, intubating and securing the airways, and placing lines to insure vascular access. Our hospital was the hardest hit in central Pennsylvania by the COVID crisis, and had one of the lowest mortality rates. CRNAs were the keystone in the successful treatment and management of these patients.”

This waiver truly has given CRNAs the chance to showcase the value they bring not only to the state’s pandemic response and recovery efforts, but also to the safe, efficient, affordable delivery of quality health care generally. Stories like these and from our earlier post prove why physician supervision should finally be removed permanently in Pennsylvania.