Susanne Madden is the Founder & CEO of The Verden Group, a consulting firm founded to help practices navigate through the increasingly complex business of healthcare.
How are you helping practices work through the chaos of Covid-19?
We are first and foremost helping practices weather the storm of Covid-19 from a fiscal perspective.
What does that mean? With the CARES Act, we are educating our clients about the program, how it works, the money potentially available, getting the applications in and focusing on helping practices secure working capital. As many who are reading this are aware, obtaining EIDL emergency ‘grant’ funds was the immediate priority, while the details of the PPP program were being worked out. The EIDL grant (up to $10,000) provided a quick, but small injection of cash for some practices. The PPP was a much more comprehensive plan to help employers weather the initial drop in revenues and keep their staff employed. As we learned, the initial budget for PP was nowhere near adequate and so we’ve had two waves of helping clients obtain this funding. However, the program only carries practices through for approximately 8 weeks of payroll; if we get a second wave of Covid-19 (or cannot get back to operating at sufficient levels to cover costs soon), it won’t be enough to save those practices that cannot tap into working capital elsewhere.
Securing the funding is one thing, but once that money is secured, we’ve been helping practices to figure out the distribution strategy and longer-term plan. Most importantly, we center our advice and guidance on “what you need”, rather than a one-size-fits-all approach. Each practice has its own unique challenges to navigate.
We are also trying to generate hypothetical scenarios illustrating what the new landscape post-crisis might look like.
What are practices doing to secure patient visits during the crisis?
We all know that visit numbers are way down, so practices have had to be agile and embrace change quickly. What that means is there is no such thing as “business as usual” anymore. This is about resilience, survival, and motivating your resources to move together toward a common goal.
Come up with a plan to educate your patients. Communications with patients and families about what your practice is doing to protect them as well as establishing transparency about procedures for visits (in-person or via tele-health).
What does patient care look like in the time of Covid-19?
Some practices are establishing specific hours for well visits. For example, an office might have mornings dedicated to well visits, have an afternoon clean up and then resume with sick patient visits in the afternoon. It’s important to provide patients with options. If a patient doesn’t want to come into the office, there is a tele-health option; if a patient does want to come in, there is a process in place to help them do that too. Setting up a ‘drive-through’ service where the staff comes out to see you in the parking lot and even setting up weekend hours of services are all tactics we are using to keep patient visits flowing.
How Do You Manage Teams & Re-allocate Staff Resources?
Practices are having to manage their businesses better in general. Managing the bigger financial picture, forecasting, and budgeting is central to survival. With patient visits diminishing, what else can the staff do? We are encouraging practices to go through patient’s records, determine who is overdue for a well visit, vaccinations, ADHD and asthma check-ups and so on. Essentially, we advise being very proactive about getting that care to patients. Practices are establishing better educational resources because of reduced facetime. We are finding back burner projects like overhauling outdated web sites, reviewing outstanding account receivable reports, and focusing on marketing practice changes (like the addition of telemedicine) because staff now have time to give their attention to these things.
Practices that apply their resources and time to get through this crisis are going to be stronger and better, but patience, flexibility, and positivity are crucial.
Telemedicine? Get on it ASAP (if you haven’t already)
In lieu of in-person visits with shelter-in-place orders still in effect, practices need to leverage innovative technology options that are ready and available for them. We are finding that practices are learning and caring for patients in new ways. For visits more focused on cognitive aspects (like ADHD management), we are finding that tele-medicine is an effective tool because it minimizes the need for in-person discussion, making it more convenient for patients during this time and frankly, anytime! We know that many rural communities have used tele-medicine for a lot longer than some of our urban area practices. What can we learn from them?
Tele-medicine is changing how doctors interact and treat their patients. Granted, there are ailments and things that tele-medicine is not optimized for, but this digital medium is here to stay and that is great news for doctors and practices worldwide. There are many options for practices to choose from including doxy.me, Anytime Pediatrics, Spruce Health, and Zoom. Make sure you are using a secure platform and look for ones that help to integrate (or at least make it easier for) documentation of the visits into your EMR.
What about tele-health and insurance company reimbursement?
There are still outstanding issues that need to shake out regarding insurance claims, reimbursements and billing that will take time to sort out. Most of the large insurance companies like United Healthcare, Aetna and Cigna had contracted with large tele-medicine companies like Teledoc in order to meet employer demand, and would not pay individual practices for offering those services. Patient uptake was slow- after all, who would want to utilize a ‘virtual’ visit platform with a doctor that you have never met before? Thanks to COVD-19, payers are covering tele-medicine services provided by participating doctors. That said, there are still issues with how much insurers are paying providers for these services- some pay an amount lesser than a level three office visit, while others (like Cigna are paying parity for in-person office visits and virtual (tele-medicine) visits. Payers have adjusted their policies to allow telemedicine to be provided generally by in-network providers through the end of June.
How can payers turn around and stop paying providers at the end of that period? I don’t think that they can; patients aren’t going to want that, or providers either, having invested the time and money into those technologies. So we will see what happens once Covid-19 passes.
What are you seeing in high-infection rate demographics like New York?
In NYC, which has been ground zero for Covid-19 for the past several months, we are seeing patients still coming into doctor’s’ offices. Many offices are staggering sick visits to ensure that patients aren’t together in the waiting room. The approach has been, call us first, see if we can triage the patient and provide the option of following up using a tele-health session, and if not, the patient can be seen in a time slot that keeps traffic decompressed. So, for patients who want or need to come in for an in-person visit, the practices are now offering a higher touch point in terms of customer service than before.
Things To Anticipate Near-Term:
The second financial wave of crisis
Practices that have received forgivable loans will be running out of capital by early summer and we are anticipating another round of laid off workers and furloughed staff. We are helping practices walk through scenarios so that they can be prepared for the management of this as well as helping them make hard management decisions. Whether this happens or not, we advise that practices have a strategy in hand and are prepared so that the best plans can be developed ahead of time. The best time to plan is before you in an emergency, right?
Looking forward
We have helped our client practices to figure out how to continue to see and service patients and embrace crisis management in order to turn the ship. So, what’s next? We don’t know how the virus is going to develop and how our national testing program availability and efficacy is going to shake out. Unfortunately, some practices are not going to survive this crisis. The practices that do weather the storm are likely to be stronger than ever. But one thing is clear: how doctors provide service to patients is forever changed and will be evolving for some time to come.