Function by function
Each of the twelve functions of this industry was reached by orders in each of the six quarters, and for each the compelled modification is stated in the orders' own terms. The instruments for each function and quarter are listed in the footnotes.
ED: emergency department and intake
In the second quarter of 2020 the section 1135 waivers redefined where EMTALA screening could be performed and the stay-at-home orders removed the department's patients; in the third and fourth quarters of 2020 and the first two quarters of 2021 the screening, testing and face-covering orders of the States and metros, the infection-prevention and exposure-control regime of every entry, governed every intake and the reporting condition of participation counted every emergency admission; in the third quarter of 2021 the federal standard's patient screening and management, distancing and barrier requirements governed every point of entry, and the crisis standards of Idaho and Alaska governed triage from September 7 and 21.114 The operation of the emergency department was partially suspended in every quarter from the second quarter of 2020 through the third quarter of 2021 because of those waiver, screening, reporting, standard and crisis-standards orders.
IP: inpatient units and surge capacity
In the second quarter of 2020 the capacity orders commanded fifty percent bed increases, twenty-five, thirty and fifteen percent reserves and surge plans; in the third quarter of 2020 Texas's reserve and re-postponement and the federal reporting condition governed; in the fourth quarter of 2020 and the first quarter of 2021 the regional triggers, transfer orders, reduction notices and reserves of Texas, Pennsylvania, California, Nebraska, Iowa, Mississippi, San Antonio and Washington governed; in the second quarter of 2021 Maryland's surge duties, Pennsylvania's order and the reporting condition governed; in the third quarter of 2021 the reporting condition with Pennsylvania's new fields and Indiana's daily diversion and staffing report, the isolation-room rule of the federal standard, the capacity orders of Tennessee, Alabama, Nebraska, Indiana and Rhode Island, the Louisiana Insurance Commissioner's order on the payers of every surge transfer and the crisis standards of Idaho and Alaska governed.115 The operation of the inpatient units was partially suspended in every quarter because the orders fixed how many beds the hospital could fill with whom, and reported the count to two governments daily.
SX: surgery and elective procedures
In the second quarter of 2020 the function was terminated by order in more than thirty States and restored only on conditions; in the third quarter of 2020 it ran on those conditions everywhere and was re-terminated in more than one hundred Texas counties; in the fourth quarter of 2020 it was suspended, cut in half or conditioned a second time in twelve States by orders keyed to the hospital's census; in the first quarter of 2021 those orders ran to their stepped expiry between January 4 and April 5 while the conditional regimes continued; in the second quarter of 2021 the conditional regimes ran to May 27, June 11, June 15 and June 30 and Pennsylvania's and Washington's orders continued; in the third quarter of 2021 Pennsylvania's order ran to August 23, Washington's throughout, the federal standard governed every aerosol-generating procedure, Indiana's Executive Order 21-24 directed the reprioritization or postponement of non-emergent procedures where necessary from September 2, and Idaho's and Alaska's crisis standards reallocated surgical capacity.116 The operation of surgery and elective procedures was fully suspended for the periods the orders terminated it and partially suspended in every quarter because of the termination, conditional-resumption, reserve, reduction, trigger and standard orders.
OC: outpatient clinics and diagnostics
The elective orders named ambulatory surgery centers, diagnostic and treatment centers and outpatient clinics in the spring of 2020; the resumption orders governed them on the same conditions; the metro orders required telehealth and limited waiting rooms; the federal standard's screening and barrier rules governed every clinic in the third quarter of 2021; and the telehealth terms of the Office for Civil Rights and the DEA governed every remote visit throughout.117 The operation of the outpatient clinics and diagnostics was partially suspended in every quarter because the orders closed, converted, conditioned or reorganized the settings in which it is performed.
VS: visitation and access
Visitors were barred by order in the spring of 2020 from hospitals in Michigan, Massachusetts, Alabama, Alaska, San Diego County and Riverside County and from nursing homes and long-term care facilities everywhere, New Hampshire's and New Jersey's among them; visitation was restored by phased directive through 2020 and 2021; and in the third quarter of 2021 California conditioned every indoor visit on vaccination or a negative test, the health-care-setting face-covering controls of New York, Oregon, Washington, Massachusetts, Connecticut and the metros conditioned every entry, and the documentation bans of Florida, Texas, Arkansas and Georgia fixed what a hospital could ask of the visitors it admitted.118 The operation of visitation and access was fully suspended for the periods the orders barred it and partially suspended in every quarter because of the visitation, infection-prevention and documentation orders.
IC: infection control
Screening, testing, protective-equipment, isolation and cohorting duties were imposed by the State resumption orders, the metro facility orders and Proclamation 20-24.2 from the spring of 2020; from June 21, 2021 the federal standard fixed every one of them in regulatory text; and from July 26, 2021 the workforce vaccination orders of thirteen jurisdictions made staff vaccination, exemption and testing a compelled program with deadlines inside or immediately after the quarter.119 The operation of infection control was partially suspended in every quarter because the orders dictated its content, and Tri-State holds that "the required protocols and procedures to comply with the Proclamation" were the order's effects.
SC: supply chain
The Defense Production Act delegations, the scarce-materials designation and FEMA's allocation rule governed the market for protective equipment from March 2020 to June 30, 2021 and the designation to November 15, 2021; the State inventory and reporting orders and the resumption conditions forbidding resort to public stockpiles governed the hospital's own supply; and the federal reporting condition counted its days on hand.120 The operation of the supply chain was partially suspended in every quarter because the commerce in which the hospital bought was allocated and conditioned by order.
HR: credentialing, travel nurses and training
The section 1135 waivers and State licensing suspensions redefined credentialing throughout; the entry proclamations kept foreign-trained clinicians out in every quarter; the interstate traveler quarantines confined travel nurses in 2020 and early 2021; the federal standard imposed training duties by July 21, 2021; the vaccination orders of thirteen jurisdictions, the employment-mandate bans of Texas, Montana and Arkansas and the documentation bans of Florida and Georgia fixed the terms of every hire, every continued employment and every admission in the third quarter of 2021.121 The operation of credentialing, staffing and training was partially suspended in every quarter because the orders fixed whom the hospital could credential, admit to the country, bring across State lines, employ and retain.
OF: administration and telework
The stay-at-home and telework orders of 2020 converted the administrative offices; the reporting orders of Pennsylvania from March 24, 2020 and of CMS from September 2, 2020 imposed daily duties with new fields in January and August 2021; the attestation, plan, verification and exemption duties of the resumption and vaccination orders fell on administration; and the federal standard reached every administrative area except off-site billing.122 The operation of administration was partially suspended in every quarter because of those telework, reporting, attestation and standard orders.
WF: workforce availability
The stay-at-home orders and school closures of the spring of 2020, the FFCRA leave mandate through December 31, 2020, the quarantine and isolation orders of the States and metros throughout, Michigan's COVID-19 Employment Rights Act from March 1, 2020 and Indiana's control measures from August 1, 2021, the conveyance order on every commute from February 1, 2021, the federal standard's mandatory medical removal with pay from July 6, 2021, the school infection-prevention orders of the autumn of 2021 and the vaccination orders' separation dates reached this function.123 The operation of the workforce was partially suspended in every quarter because the orders confined it, removed it by quarantine and medical removal, compelled paid leave, attached the airborne-transmission control of face coverings to its commute and, in the third quarter of 2021, separated the unvaccinated portion of it by law.
CB: patients and payers
The stay-at-home orders confined the patient base in the spring of 2020 and the winter of 2020-21; the nursing-home admission, visitation, testing and vaccination orders of CMS and the States governed every discharge in every quarter; Medicare's rules were rewritten by four interim final rules; and the vaccination-documentation bans of four States fixed what a hospital could ask of a patient in the third quarter of 2021.124 The operation of the hospital's relationships with its patients, its post-acute counterparties and its payers was partially suspended in every quarter because every one of them was under an order limiting the commerce between it and the hospital.
MK: community programs and events
The gathering bans of every State and metro terminated the industry's health fairs, screenings, blood drives, classes, fundraisers and meetings in the spring of 2020; the caps of 2020 and the winter of 2020-21 limited them; and the masked-entry, proof-of-vaccination and event-capacity orders of the metros in the third quarter of 2021 conditioned them.125 The operation of community programs and events was fully suspended in the spring of 2020 and partially suspended in every quarter thereafter because of the gathering, capacity, masked-entry and proof-of-vaccination orders.