Make plans, be flexible
Implementing telehealth was critical in responding to the coronavirus pandemic. We were able to get up and running quickly on telemedicine because we had already invested in telehealth and had conducted a pilot of the platform with a smaller group of providers well before the pandemic hit.
In March, we were able to expand the telehealth platform to accommodate virtual visits by all of our providers. We also had to figure out how to shift our employees to telework, develop remote desktop and VPN solutions, and make sure that our scheduling and revenue cycle team members were fully operational.
The overriding goal was the safety of patients, staff, and our providers while continuing to provide medical care. Our inflammatory bowel disease patients needing visits to receive medication infusions took over an entire office so that there could be appropriate spacing and limited contacts with staff and other patients.
Our administrators knew early on that we needed a back-up plan and worked with physicians and providers doing telehealth visits to provide the flexibility to switch to Centers for Medicare & Medicaid–approved platforms (including Facetime) for those instances in which patients were uncomfortable using our main platform or when it was strained by bandwidth issues – a common challenge with any platform. Virtual check-in and check-out procedures were developed utilizing our usual office staff from remote locations.
For patients who had indications for gastroenterology procedures, we established a prioritization system, based on state guidelines, for those that were needed urgently or routinely as our endoscopy centers began to reopen. Safety measures were put into place including screening questionnaires, preprocedure COVID rt-PCT testing, personal protective equipment, and workflow changes to achieve social distancing.
As an early-career GI physician who is considering private practice, you’ll likely have several conversations with administrative leaders when deciding what practice to join. Ask about how the practice responded to COVID-19, and what processes it has in place to prepare for future emergencies.
During the early weeks of the pandemic, the CDC Board of Managers met two to three times per week. Task forces to discuss office operations and planning for ambulatory surgery center opening were established with participation by nearly every provider and manager. Communication between all providers and managers was important to decrease the obvious anxiety everyone was experiencing.
Old financial models may no longer work
Most practices develop budgets based on historical data. We quickly figured out that budgets from historical forecasts no longer worked and that we needed to understand the impact to budgets almost in real time.
We immediately looked to conserve cash and reduce expenses, requesting that our large vendors extend payment terms or provide a period of forbearance. We looked at everything from our EMR costs to lab supplies and everything in between.
Changing how we modeled our budgets and reducing costs made some of our hard decisions less difficult. While we had to furlough staff, our models for reducing physician compensation and lowering our costs allowed us to create a model for the return to work that included the use of paid time off and paid health care for our furloughed employees.
Our operations team also set up systems to gather information that was needed to apply for and report on federal loans and grants. They also set up ways to track revenue per visit and appeals for denied telehealth and other services in an effort to create new models and budgets as COVID-19 progressed. The revenue cycle team focused on unpaid older accounts receivable.
