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    So you’ve reopened your practice — now what?

    The next steps as public health officials continue to combat the COVID-19 crisis will require medical practice leaders to understand patient sentiment regarding telehealth services and the potential for returning for in-office visits in the months ahead.

    In a recent webinar presentation, Stewart Gandolf, chief executive officer, Healthcare Success, and Rob Klein, founder and chief executive officer, Klein & Partners, outlined recent research into patient perceptions around healthcare delivery amid the pandemic and their consumer behaviors, and detailed how healthcare marketing strategies should shift given attitudinal changes.

    Klein’s role as a market researcher led him to embark on a multi-phased study to gauge patient-consumer sentiment as the COVID-19 crisis evolves. “As we all know, how people feel today is not the same as how they felt a month ago, and it won't be the same as they feel a month or two from now,” Klein said.

    Where are we on the curve?

    Klein’s study noted a significant change in consumer opinions from early April, highlighting that most Americans believe we reached the peak of COVID-19’s spread in May and are now slightly past the peak. This comes despite 75% of people not knowing anyone personally who has been infected with the coronavirus, and relying on media, politicians and other sources for information.

    “There's a level of frustration of, ‘I don't know what to believe,’” Klein said. “Consumers are not really trusting those sources, and so you as a provider — never before have you been this trusted,” which will lend legitimacy to the voices of providers and medical practice brand messaging.

    Jumps in virtual care, an impetus for telebehavioral health

    Klein’s study that ended in May found that virtual visits surged more than twofold versus similar research in the early weeks of the pandemic, tracking the new behaviors patients had taken in seeking healthcare.

    “We are seeing a sea change in how people seek care,” Klein said. “The coronavirus is really showing that … time is the new currency,” and that quickly innovating as many practices did in March and April can make a tremendous difference. “We've now proven that we can innovate quickly, so in a way we've almost created our new normal,” Klein added. “Now we have to keep adapting and innovating quickly because consumers have come to expect it.”

    It also remains crucial for providers and payers to understand the importance of virtual mental health services, Klein said: 7% of respondents noted they started a virtual mental health session in recent weeks. “People are suffering so much right now” amid job losses and other emotional strains of the pandemic, Klein said. “As providers, we cannot look at the coronavirus as something that just broke our body, that was a physical challenge — this is having an emotional, a spiritual and a financial impact on people.”

    Getting patients back, in-office and virtually

    After pandemic concerns have ebbed, almost half (49%) of patients responded they would return for an office visit with their primary care provider (PCP), which was especially true among older patients, Klein noted.

    About 28% of respondents said they definitely will continue virtual visits. Additionally, the level of concern among patients seeking non-COVID-19 care at healthcare facilities is significantly higher among those working from home, female patients and patients who identify as Democratic voters. Additionally, patients who were most intent on shifting to virtual visits included higher-income patients, female patients and non-seniors.

    “The key is we need to come off looking like we are proactive innovators, not reacting,” Klein said. “Consumers want a calm, proactive voice from us. … They want to see that we've figured out what to do here long term.”

    At the same time, numerous consumers report some hesitance to immediately return to social gatherings, concerts, conferences and similar events. “We're seeing a lot of Americans saying, ‘even if you open things up, I'm not going to be the first one to go back,’” Klein said. “That is something we have to look into and be prepared for — just because we want them back and we're ready for them to come back from a healthcare standpoint doesn't mean they're ready to come back.

    “We have to really make it comfortable for them … [and] lessen their concerns that they have,” Klein said. Otherwise, a large percentage of patients are changing over to virtual visits. “Virtual visits pop up to the surface,” Klein said. “It is truly our No. 1 opportunity for getting patients back for care.”

    Indeed, when asked about the tradeoffs they would be willing to make, a majority (28%) of patients said they would prefer to switch to a virtual visit versus seeing another doctor in the same office (18%), seeing a nurse practitioner (NP) or physician assistant (PA) in that office (21%), seeing another doctor in a different office (17%) or seeing an NP or PA in another office (18%).

    What motivates patients

    While patients may seem cautious to come back to in-office visits, safety concerns are not the top motivator for a patient to switch to a new provider, per Klein’s research. Instead, “attitude” and “access” were the top reasons.

    The access component speaks to the already-known frustrations for patients around time to appointment. Klein said appointment cancellations across multiple procedure and visit types rose in May, affecting about 1 patient in 10 per his research. When it came to follow-up visits, consult visits and mental health sessions, a large number of patients changed to a virtual visit rather that waiting to reschedule.

    “Instead of trying to get everybody in physically … the more we can adapt to virtual, that’s going to ease the strain on patients who have to physically come in,” Klein said.

    In addition to attitude and access, concerns with safety and cost were top reasons that might be influencing factors for switching to a new provider. “Consumers just expect that they’re safe when they go into a hospital or doctor’s office pre-COVID,” Klein said, but that has changed and may require further work to inform patients how you’re keeping them safe. “We have to train our front-line staff not only to have the facts and to have solutions, but to do it with an empathetic attitude,” Klein added.

    Klein’ research found the top actions practices can take to ease safety concerns focus on physical separation:

    • Social distancing in the waiting room
    • Seeing providers wearing masks and gloves
    • Keeping COVID-19 patients in a completely separate area from non-COVID-19 patients
    • Waiting in your car or outside until it’s time for the appointment.

    Communicating the right way

    While many patients prefer to shift to virtual visits, the process of rescheduling may benefit from the personal touch of a phone call. Klein’s research found that 65% of patients prefer a call rather than online for rescheduling appointments. “During this time, they want to talk to someone,” Klein said. “They want answers that are more complicated than switching a Monday to a Thursday appointment.”

    As Gandolf noted from personal reference, trying to get a procedure today involves far more variables than before, such as a clinic’s guest/visitor policy, whether you have to wear a mask and where a patient can be dropped off and picked up.

    Emails and text messages also ranked highly in terms of preferred methods for communicating information to patients about what’s being done to make it safe for them. This appears to be much more effective than website updates, since most patients already check federal and local public health agency sites for information. “Don’t just put a COVID page on your website and expect everyone to come running to you, because they won’t,” Klein cautioned. “If you want them to come to your website for information, you’ve got to get them there,” which requires some combination of email, SEO and/or social media strategy.

    When it comes to actual messaging, Klein says that patients want information about action — this should include explanations of how to prepare for a visit, what to expect upon arrival and throughout the visit, how the practice will maintain social distancing and how COVID-19 patients are being handled.

    “All the ads on TV talking about, ‘stay strong, we’re alone together,’ — all those motivational ones, those are really wearing thin on people’s nerves,” Klein said. “They’re getting sick and tired of all that ‘Kumbaya’ [stuff]. Now is the time for action.”

    “There’s kind of a shrug of, ‘I don’t know who to trust,’ [from patients],” Gandolf added, noting that local providers who can calmly explain and reassure patients will do much better than those who provide “soft, fuzzy messages.”

    Other considerations

    • Negative emotions (e.g., loneliness, fear, anxiety) are beginning to diminish among consumers after many weeks of living through the pandemic, but these perceptions remain higher among younger patients and female patients, per Klein’s research.
    • The massive job losses across the country has put significant financial strain on patients. Per Klein’s research, patients who have lost their job are more concerned now with establishing payment plans or extending payment dates.
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