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    Chris Harrop
    Chris Harrop

    As medical practices work to return to pre-COVID-19 volumes and revenues, there remains a need to plan for a potential downturn later in 2020 if a resurgence of coronavirus forces new shutdown orders for parts of the economy or stay-at-home orders for your patient population.

    Key considerations for these scenarios were recently explored in the virtual town hall, “Preparing Your Practice for COVID-19’s Second Wave,” featuring:

    • Brian Ramos, MBA, CMPE, chief operating officer, Capital Anesthesia Partners
    • Cameron Cox III, MHA, FACMPE, president and CEO, MSOC Health
    • Maddox Casey, CPA, member, Warren Averett
    • Nelson Gomes, senior vice president of development, Medicus IT
    • Nan Gallagher, JD, principal, The Nan Gallagher Law Group.

    1. Money matters

    Remaining financially solvent after months of reduced volumes and revenues is still a top priority, according to Casey, adding that rebuilding capital reserves should be a major focus in preparation for getting back to pre-pandemic levels and in preparation for another downturn.

    Barring new rounds of federal aid, it’s important to continue optimizing collections through paperless options for all types of appointments, Cox said, and to consider extending measures to curtail discretionary expenses longer than initially envisioned.

    Additionally, a review of your collections performance can help identify areas of improvement for your revenue cycle, Casey said.

    Ramos added that he has worked from home before the COVID-19 pandemic and that healthcare organizations should take new approaches in thinking about what work must be done in the clinic space. “Challenge all the assumptions that you’ve worked under for 20, 30 years, and realize that you have to be creative to solve the problems that are presented before you today,” Ramos said.
    Ramos added that practice leaders should also ensure they have a very strong charge-capture system. When COVID-19 spikes, “you'll need access to cash as quickly as you can,” which means ensuring that you reduce the amount of time it takes to capture all charges in the system and bill them out to a carrier. “That needs to be within 24 hours, 48 at max,” Ramos said.

    2. Right-size your practice, both in staff and visitors

    Ramos noted that the largest expense in a medical practice is payroll, and that with lower volumes of patient visits, “there’s a tremendous opportunity for vacancy savings” if you limit payroll expenses for positions that are not needed in slower times.

    Gallagher echoed this, recommending that bringing back staff who were furloughed or laid off should be done only if “proportionate to your patient volume and your projected growth.

    “Only bring back enough staff to do competent, diligent, non-negligent job functions [where] no ball is being dropped and no malpractice is taking place,” Gallagher added.

    To accommodate social distancing in the physical environment of your office space, it is best to avoid any unnecessary people present, whether patients, family members (e.g., spouses, children), vendor representatives or staff, Ramos said. “I would continue to limit the number of visitors that are permitted,” Ramos added. “Non-patient-facing staff should be allowed to continue to work from home in order to be able to reduce the potential spread” of COVID-19.

    Another method for accommodating patients beyond the confines of your physical space is working beyond the normal schedule, Ramos said. Expanded weekday hours and weekends further allow you to stagger provider and staff into shifts as volumes increase.

    Gallagher recommends that practice leaders check with the state government for a consumer or regulatory affairs division for specific guidance on visitor and reopening policies on a regular basis. In some cases, Gallagher added, it might be necessary for practices to ensure that there are safety measures for patients who might have difficulty ambulating without a caregiver or family member to assist, especially around stairs, to mitigate risk of falls and the potential for lawsuits.

    3. Make your providers and staff feel safe

    Numerous physicians, clinical team members and staff may still be wary of returning to clinics, especially in areas where COVID-19 infections are spiking again. As Gallagher noted, the reluctance to return to work for more cautious team members can disrupt plans for resuming or expanding operations.

    While financial incentives such as productivity-based bonuses based on revised RVUs for your practice’s “new normal” may not be feasible, all practice managers should be able to communicate that they have “an ironclad, COVID-proof” practice that complies with the latest guidance from federal and local health agencies. “Once the employees feel that it’s a safe place to return to … they’ll want to return,” Gallagher added. Ramos added that providers who may not be comfortable with returning to the clinic should be prime candidates for shifting toward telehealth services from the safety of their home office.

    4. Evaluate HIPAA compliance and optimize your cloud

    Gomes noted that many technological solutions added on an interim basis for telehealth might be ready for re-evaluation, and that now is the time to review your needs. While there are numerous emergency waivers in place from the Department of Health & Human Services (HHS) — known as 1135 waivers, based on section 1135 of the Social Security Act, which authorizes temporary waivers of rules — it may not be wise to base vendor and platform selection decisions on those waivers beyond the end of the public health emergency (PHE).

    “Stay compliant, remain compliant,” Gomes urged. “Why put yourself at risk if you don't have to?”

    Similarly, Gomes said that this is the right time to work on making as many “mission-critical applications” available via the cloud so that the right staff and providers can access them easily while working remotely.

    “Connectivity is king,” Gomes said, adding that “softphones,” which can make calls via the internet or rely on users’ cell service, are an area to consider implementing to promote ease of communication on your team. “Collaboration is key, and it’s not just video,” Gomes said, adding that Microsoft Teams remains free for use and helpful for managing chats, meetings and file-sharing.

    Ramos added that staff who are working remotely are excellent options for testing your virtual private network (VPN) and other systems for latency and any lags. “Test those systems with employees working from home before we’re all forced to work from home” when a second wave hits, Ramos urged.

    5. Defend your practice’s online reputation while building your digital outreach

    Given the politically charged nature of the pandemic in the United States, Cox said that many patients may have “very distinct” stances about issues, such as wearing masks and social distancing, which could lead to negative comments about the practice on review sites.
    “Be prepared for negativity with your star ratings,” Cox cautioned, adding that now is the time to craft standard responses for negative comments and ratings so that the practice can provide positive comments and avoid being reactive.
    This is also a great time to ensure that your practice has gathered email addresses from patients to assist in digital communications about practice updates throughout the pandemic.

    6. Ensure top-of-licensure work

    In addition to work to limit unnecessary personnel, now is the time to make sure the staff who are working are doing the right kinds of work, toward the top of their licensure, Casey said.

    “A lot of practices I go into, an RN is doing an MA’s duty,” Casey said. “That’s terrible.” Even if you have the right number of people, you may be overpaying and depleting capital reserves if higher-paid nurses are doing work normally done by medical assistants.
    Similarly, “you want to make sure that you’re paying them the right amount for their licensure,” Casey added, urging that practice leaders should seek out benchmarking information to ensure nonphysician provider salaries are appropriate for the region where they work.

    7. Find talented new hires while they’re available

    “Now’s the time to go after talent,” Casey said of practices that have preserved capital appropriately to continue to grow. “There’s a lot of [available] talent on the market — get after it, go find them and add them to your practice while they’re sitting at the house or they don’t have the opportunity to do what they do in their current practice.”

    8. Consider your office space and options

    If your practice continues operating with fewer non-patient-facing staff teleworking, it is time to evaluate your physical space, Gallagher said. Whether you have too much space or were already paying more per square foot of commercial real estate than you should, Gallagher advised a review of any leases and their termination clauses so that you can consider other options.
    Similarly, practice leaders should understand their options for subleasing unused space or renegotiating for new terms.

    Chris Harrop

    Written By

    Chris Harrop

    A veteran journalist, Chris Harrop serves as managing editor of MGMA Connection magazine, MGMA Insights newsletter, MGMA Stat and several other publications across MGMA. Email him.

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