6 keys to medical practices’ recovery amid COVID-19

After mandated closures and limits on elective procedures eased, the healthcare industry has seen peaks and valleys in terms of productivity and compensation during the COVID-19 pandemic, often in correlation to subsequent waves of coronavirus infections across the country.

MGMA’s recent report, Quantifying COVID-19: Measuring the Pandemic’s Impact on Medical Practices, drew upon quantitative data collected throughout 2020 from practices nationwide to provide direct insight into how key performance metrics shifted as the pandemic progressed. (MGMA members can read an excerpt in the April issue of MGMA Connection magazine.)

During an April 28 webinar, MGMA’s Andrew Swanson, MPA, CMPE, vice president of industry insights, and Meghan Wong, MS, director of data solutions, detailed the findings of MGMA’s monthly survey throughout 2020 and insights from interviews with practice leaders on how they responded and innovated to sustain financial viability and work back to pre-pandemic levels of volume and revenues.

Here are 6 key takeaways from their presentation:

1. Patients came back for care in summer 2020 after safety worries, deferred visits

Despite the catastrophic drop in patient volumes and revenues in March and April 2020, the MGMA monthly survey found that many practices quickly restored productivity, with some reporting RVUs in July 2020 at the same level or even higher than January and February 2020 levels.

The survey data help confirm a June 2020 MGMA Stat poll that found 87% of healthcare leaders reported that their practices had recovered some patient volumes since the pandemic’s start, with nearly half of those recovering back to more than 75% of their pre-COVID-19 patient volume.
 
However, a poll of the more than 100 webinar attendees of when their volumes returned to pre-pandemic levels found that practice leaders were somewhat split as to whether it was June (26%), July (21%), August (17%) or September (36%). “I think this data shows that, depending on where you are in the country, what type of practice you are operating … people had widely varying degrees of when volumes came back,” Swanson said.

In some cases, this was a matter of restrictions on elective surgeries being removed in certain states before others; however, attendees noted that patients with high-acuity care needs returned with worsened conditions after delaying care. (Read more about this in the MGMA-Humana research report on deferred care, No Time to Waste.)

2. The recovery was short-lived due to the fall 2020 COVID-19 surge

Despite the boost for many practices throughout the summer months, the resurgence in COVID-19 infection rates in early fall 2020 took a toll on practices again, with surgical practices hit hard in September and October, and a leveling off for recovery in gross charges toward the end of the calendar year.   

3. Telehealth surged, then ebbed, then grew again with new waves of COVID-19

While MGMA data pointed to nearly all medical practices embracing some form of telehealth in the early months of the pandemic, the 2020 monthly survey report found that providers did not report the vast majority of their wRVUs as coming from virtual care delivery.

As Swanson noted, data on primary care, nonsurgical specialists, surgical specialists and advanced practice providers (APPs) showed a massive spike in telehealth wRVUs for March and April, but for some segments of the provider data, telehealth as a percentage of all wRVUs never rose above 50% — only to plunge in the summer months as patients returned to in-person care visits.

But toward the end of 2020, telehealth wRVUs began to pick up again as COVID-19 infection rates rose in many areas of the country. “Perhaps what this tells us is that, as patients are coming through to the other side of the pandemic and they’re reflecting on things they experienced, perhaps there is an ongoing place for telehealth visit volume at a significant degree,” Swanson said.

4. Slow periods for productivity were opportunities to catch up on collections

With fewer patients coming through the doors in person or virtually, the significant drop in volumes and claims to submit in the first half of 2020 provided medical practice leaders an opportunity to focus their staff members’ attention to work through accounts.

Interviews done for the report found multiple MGMA members reporting a redeployment of staff to do other tasks internally that might not have been done in busier times, such as putting billing staff to work to look at back charges and addressing aging A/R to improve collections and avoid bad debts, Swanson noted.

MGMA’s survey data showed a decline in charge collections for primary care practices around August and September — likely a product of the significant drop in professional gross charges in the spring months that preceded.

5. Supply costs were up dramatically, but cuts elsewhere lowered overall spending

While the market for personal protective equipment (PPE) tightened dramatically throughout much of 2020 and prices for items such as masks, gloves, gowns and other protective gear surged, practice leaders more than made up for those increased costs by trimming total costs in other areas.

A poll of webinar attendees found a majority (54%) had an overall decrease in operating costs for 2020, compared to 23% whose costs rose and 23% whose costs stayed the same. For practices that accepted Paycheck Protection Program (PPP) loans, the need to retain those employees kept those staffing expenses on the books, whereas other practices that opted for furloughs and layoffs saw a lot of cost savings to account for dramatic loss of revenue in early 2020.

“It might be a bit counterintuitive, thinking about groups trying their best to stay afloat — that operating expenses would decrease and, in some instances, decrease significantly,” Swanson said, but as the report notes, “decisions to cut spending elsewhere in the practice … likely mitigated the overall impact” of PPE price hikes.

6. Staffing struggles persist due to quarantine, childcare and a tight labor market

Practice leaders interviewed for the report all pointed to the need to update staffing models to accommodate for potential employee quarantines if exposed to coronavirus, as well as updating staffing schedules due to family care needs after schools and daycare facilities closed during the pandemic.

These factors — paired with a tightening market for physicians, various types of APPs and staff — speak to a need for healthcare practice leaders, especially in human resource management, to rethink their long-term strategies.

With more than 70% of practice leaders planning to hire a new physician position in 2021 after a rash of unexpected physician retirements in 2020, “an already tight and already difficult recruiting market is going to get even more tight,” Swanson noted. To fill that gap, hiring APPs might be an alternative approach for practices looking to add providers as recovery continues: A November 2020 MGMA Stat poll found more than half of practice leaders expect to add new APPs this year. “I think this really points to [the need] to think more strategically about how to get ahead of this,” Swanson added, such as getting workers performing tasks at the top of their licensure and building out pipeline/feeder systems in the community for bringing in new talent for certain clinical support staff positions. “If your nursing staff is bouncing around practices in town or between the hospital or hospital systems ... you’ve got to have a feeder system,” Swanson implored.

It also might be necessary to consider reaching out to recently retired physicians to help fill the need for part-time physicians to either grow your available providers or accommodate desires for other doctors to improve work-life balance after a challenging year that only intensified feelings of burnout.

Additionally, building more into the employee onboarding process is a crucial way to lay the groundwork for better retention as compensation and benefits become more competitive. Making those early days and weeks “memorable and extremely positive” to leave a lasting impact as a new employee integrates with your team might make the difference in keeping that person when an offer for better pay comes along, Swanson said.

“Really make a strong impression out of the gate — in the first day, in the first week, in the first month of somebody's employment — so that when somebody comes knocking on the door, or the workday gets really hard on Day 45 or on Day 68, they can reflect pretty quickly back on an experience they had that says, ‘This is worth it. It's worth it for me to stay here. I'm doing really good work,’” Swanson said.