Safety, unpredictable volumes and fear pose challenges for reopening medical practices amid COVID-19

MGMA Stat - May 7, 2020

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The Medical Group Management Association’s most recent MGMA Stat poll asked medical practice leaders, "What is your biggest challenge in reopening your practice as stay-at-home orders start to lift?" Top responses included:
  • Developing safety protocols in the office and ensuring appropriate supplies: About 48% of respondents expressed concerns about implementing and maintaining safety protocols for staff and patients; ensuring social distancing among patients and staff as patient volumes increase; and making sure the practice has adequate personal protective equipment (PPE), cleaning supplies and other needed supplies for resuming even limited operations and eventually ramping up toward normal levels of volume.
  • Unpredictable patient volumes: Across specialties, there is a tale of two burdens facing medical practices — overwhelming demand for patients to come back for face-to-face visits and patients being reluctant to make appointments. Many respondents noted that these patient levels have been unpredictable, making it difficult to match staffing levels effectively.
  • Managing patient and staff fears of exposure: Practice leaders pointed to a handful of concerns from employees and patients alike that complicate reopening, such as:
    • Providers not agreeing on when to reopen
    • Employees wanting to continue working from home
    • Concerns about infection risk and a lack of adequate testing kits and PPE.
The poll was conducted May 5, 2020, with 602 applicable responses.

As many states begin to reopen and allow elective procedures, medical practices that have seen severe drops in patient volume and revenue in recent months are faced with creating reopening plans for phasing in elective procedures and non-essential visits.

Well-defined, precautionary measures to keep patients and staff safe — such as requiring patients to wait in their cars instead of waiting rooms, and heightened cleaning of facilities — are critically important. That means balancing new protocols for use of personal protective equipment (PPE) against the added costs and loss of productivity.

Along with the massive task of reopening, practice leaders are faced with how to address bringing back providers and staff after furloughs and layoffs to address a likely backlog of patient care.

Meanwhile, regulatory action to implement more flexibility on telehealth and telephone visits means that practice leaders must maintain a close eye on developments from the Centers for Medicare & Medicaid Service (CMS), other federal entities and commercial payers.

Safety first

Frank J. Chapman, MBA, director of strategic development, Ohio Gastroenterology Group, recently joined the MGMA Executive Session podcast to share insights from the American Society for Gastrointestinal Endoscopy (ASGE) report he helped craft. The report, Guidance for Resuming Elective GI Endoscopy and Practice Operations after the COVID-19 Pandemic, is a substantial paper with relevance beyond GI specialists in terms of a framework for reopening a practice with patient, provider and staff safety top of mind.

The paper includes specific guidelines for how to:
  • Screen patients prior to a procedure
  • Create a safe facility with appropriate social distancing
  • Establish appropriate use of personal protective equipment (PPE) to safeguard patients, staff and providers
  • Create a written scheduling policy that prioritizes patients with the most need
  • Provide checklists that cover patient check-in, the pre-operative and postoperative rooms and (more importantly) the procedure room
  • Clean the procedure room.
Hear more from Chapman in the Executive Session podcast

“We’re familiar with universal protocols that came out of the era of HIV/AIDS. I think we’re entering a new universal protocol in terms of how you have to assume a patient may be infected and how to treat them,” Chapman added.

One major consideration is understanding what your practice’s PPE burn rate will be, which will vary among specialties and be influenced by how high your in-person patient volumes are upon reopening.

As noted by Jeff James, chief executive officer, Wilmington Health, in a recent AMGA/MGMA joint webinar, not understanding your PPE needs as patient volumes rise can hamper your ability to get closer to normal levels of productivity.
Access the CDC's PPE Burn Rate Calculator

The big picture

The Centers for Medicare & Medicaid Services (CMS) in April issued guidance on resuming non-essential procedures in areas with low incidence of COVID-19, but it’s up to each state and locality to decide when and how stay-at-home orders are lifted, as well as how many businesses begin a phased process for reopening and returning to normal operations.



In a recent webinar presentation "COVID-19: Planning to Re-Start Your Practice," Brian Ramos, MBA, CMPE, chief operating officer, Capital Anesthesia Partners, and president, Maryland MGMA, detailed a number of considerations related to managing this unique time as parts of the country look to loosen mandated closure orders while still including some social distancing guidance.

With insights from Ramos and MGMA subject matter experts, a Medical Practice Reopening Checklist has been developed to help practice leaders outline the various financial, operational, staffing and procedural considerations to resume operations and ramp up work in the coming weeks, depending on your locality and state.

Download the Practice Reopening Checklist now (PDF)

Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at: mgma.com/stat.

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