March 20, 2020
As consultants we are in daily communication with surgeons across the country. In the last few days, calls and emails have spiked from concerned doctors and managers worried about making payroll or paying the credit card bill. Surgeons are making difficult decisions about patients, staff, and the practice.
Consider these nine strategies to manage cash flow during the COVID-19 Pandemic.
1..Evaluate options for performing surgery – emergency only or can you still do elective cases? The recommendations and restrictions are changing by the hour, but most states are stopping all elective cases, though the term elective could be subjective.
The American College of Surgeons suggests using the Elective Surgery Acuity Scale from St. Louis University to assist in the surgical decision-making process to triage non-emergent operations. Check with your specialty society on other specific recommendations.
2. Implement telehealth visits. One office we work with is calling post-op patients at their scheduled time to prevent an unnecessary trip to the office. Though a phone call is not a true telehealth visit, it is a viable option for a quick check-in with patients who are in a global period.
Check with your EHR vendor about integrated telemedicine technology for conducting virtual visits. Outside vendors to evaluate include Doxy.me (offers a free solution), OrthoLive and Rezilient. A long term plan to offer telehealth visits will help preserve some cash flow when you cannot operate.
The government is relaxing telemedicine requirements to allow for payable visits through expanded technology. The legislation is changing daily. The Center for Connected Health Policy developed a helpful fact sheet summarizing the developments to date. Check back as it is a living document that will continue to be updated as enhancements are announced.
Be sure to read our blog post on operationalizing telehealth into your practice.
3. Consider scaling back office hours and/or wages. Some offices are converting to a four-day work week effective immediately. Others are cutting hours and reducing wages by 10%. Still another practice is committed to paying employees full wages for up to four weeks and will re-evaluate at that time.
4. Set up 1-2 employees to answer calls and schedule appointments from home if needed. Refer to the Telework policy provided by the Medical Risk Institute and ensure appropriate precautions are taken to maintain security and privacy of practice information and Protected Health Information (PHI). Consider providing remote workers a practice laptop that is used exclusively for practice work rather than a home computer shared by family members.
Check with your phone vendor about remote options. Most modern phone systems provide portability where business calls can be answered from a virtual line. Otherwise, look to forward calls to another number should the office be closed or staff need to work from home.
5. Review your business interruption insurance. Contact the carrier and inquire if this is a covered event. From what we’re hearing, most policies only consider it a covered event if the surgeon is disabled from the COVID-19 virus, but we think it’s worth asking.
6. Contact your banker to establish or increase a business line of credit to provide some financial breathing room. Refer to the KZA Blog post “Why Your Practice Needs a Line of Credit.“
Having trouble making loan payments? Contact your banker to determine if they have debt payment relief programs available.
7. Visit the SBA Disaster Loan Assistance website and determine if your state and county have issued a declaration for emergency that qualifies for relief status.
8. Contact credit card companies and other vendors to request an extension. One surgeon reported that AMEX granted a penalty-free, interest-free extension for 60 days.
9. Issue a full court press on your A/R. Get all hands on deck to work old accounts and spur reimbursements.
Of course, it goes without saying that each office should take extreme measure to mitigate the spread of COVID-19.
– Review the CDC guidance: https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-patients.html
– Implement a policy about “no fever” or other symptoms. Send a clear message: If you’re sick, stay home. This applies to everyone – staff, patients, and DOCTORS.
– Consider establishing special hours, like first thing in the morning, for seeing patients over the age of 60, mitigating their exposure to others.
– Work with HR to determine a plan to address the possibility that an employee or an employee’s family member becomes infected with COVID-19.
– Screen patients during reminder calls. Ask about symptoms, recent travel, and possible exposure to an infected person.
– Ask patients to call the office from their car when they arrive. Text them when an exam room is ready, reducing patients sitting in the waiting room.
– Limit the number of people in an exam room – ask patients to leave family members at home if possible.
During these unprecedented and uncertain times, remember to communicate frequently with your staff and patients. Avoid seeming cold or impersonal and check-in often. Perhaps start a group text via WhatsApp or Microsoft Teams to keep in regular communication when email access may be limited.
Crises provide an opportunity for people to come together and form a bond that will persist long after the crisis is over. Be kind and help each other. And if we at KZA can be of help, please call.