This is the third of a four-part series prepared by Marcum, LLP, to help podiatry practice owners understand COVID-19 resources available to small businesses and to begin planning for recovery. The other articles in the series are linked below:
It is a paradox that the medical industry itself is a victim of the COVID-19 pandemic. While COVID-19 cases have strained hospital systems to their breaking point, stay-at-home mandates have had the opposite effect on medical practices. Elective procedures—the greatest source of revenue for specialty practices—were put on hold, worried patients canceled appointments in droves, and many practices were forced to lay off staff. As industries throughout the US continue to grapple with the economic repercussions of mandated shutdowns, we’re now entering the “what’s next?” phase. As the economy reopens, how does your practice successfully emerge from COVID-19?
According to the Medical Group Management Association (MGMA), physician practice revenues decreased by 55 percent on average since the COVID-19 pandemic began. Patient volume in independent practices has fallen by an average of 70 percent. As a result, many practitioners are encountering difficulty in meeting overhead expenditures.
As Medicare and private insurers expanded coverage to include telehealth services in place of in-person visits, practices equipped with the right technology have been able to somewhat bridge the gap through this revenue stream. Still, telehealth visits aren’t as financially beneficial, so physicians must consider other means of restoring the financial health of their practices.
Federal disaster relief was made available to small businesses through the Paycheck Protection Program (PPP) and other small business loans. However, these funds—which were quickly depleted—were meant to support businesses through this rough period. Patients may not come flocking back to a practice, as the coronavirus continues to be a threat for the foreseeable future. Seniors may be less willing than others to visit their practitioners for fear of exposure. So, what steps can you take?
In addition to following CDC guidelines, it is very important that you communicate with patients through all channels available (phone calls, letters, emails, social media) what actions you are taking to follow these guidelines, including pre-screening patients, social distancing, office sanitization, and the use of masks. As you connect with patients to schedule their appointments, be sure to convey that you are limiting the number of people in the office (per CDC guidelines) and that it may take a bit longer than usual to schedule appointments. Above all, assure patients that you are minimizing exposure at your practice. In addition, these assurances will also help your staff feel more comfortable about returning to work.
Just as you attend to the health of your patients and staff, you must attend to the financial health of your practice. It’s always essential to carefully monitor your cash flow and apply best practices to manage your revenue cycle. However, during these times, you will need to meet with your practice manager weekly to know what your numbers are. You need to bill insurance daily, whether it is Medicare or private insurers. Be sure to follow up with insurers on contested bills to resolve quickly. It will be critical to keep an eye on expenses while revenue is down. Communicate with patients with past-due accounts. If they are experiencing financial hardship due to COVID-19, work out a payment plan with them and state clearly what that plan is, then follow it.
You will also want to clearly document any disaster relief loans or Medicare reimbursement monies you have received in your financial system and track expenditures against those funds with backup.
Treat your practice like a startup. If you have had to lay off employees, don’t bring them back all at one time. Have a plan and communicate clearly with your staff about that plan. It is important to understand that your staff may not be able to withstand long layoffs and they may seek other opportunities.
Remember, it’s going to take some time to get your patients back. Make sure your expenses don’t overrun your revenue. You may have to delay full staffing by a number of months until you have a healthier cash flow.
Review your patients’ needs and schedule accordingly. Prioritize those with the most critical requirements, such as those with outpatient surgical needs. Many have postponed elective surgery, so it’s time to re-engage with them now that the hospitals and outpatient surgery centers have capacity. Then, consider chronic patients who need to come in on a regular basis. Many will be seniors who have other health-care issues, so you will need to determine how you can mitigate risk for them. It is important to balance the needs of your patients with the needs of your practice (financial and staffing capacity).
You’re busy—that’s understandable, especially if you’re working with a leaner staff. At the same time, you need to implement a strong communications plan that is about more than scheduling appointments. These are uncertain times. We don’t know if or when there will be spikes in COVID-19 cases and what will happen later in the year. That’s why you need to be in constant “start-up mode.” How can you communicate all the services you provide? How can you build trust within your patient base while attracting new revenue to your practice? Think in terms of:
Your practice was likely built on strong and trusted relationships among patients, your staff, and yourself. It is important that any communications reflect and build on that trust. Communications that are caring and personal (phone) will likely be better received than those that are not. Take a few extra moments in your communications to think about the person on the receiving end of the message and how your message will be perceived. Don’t hesitate to invest in your staff for training on empathetic phone communication skills.
These steps rely on a strong database, so be sure you are updating email addresses, phone numbers, and other key contact information. The more you keep your lists updated, the easier it will be to customize messages to the patients most open to receiving the information and the method in which they prefer to receive it. Once you go from reactive to proactive, you will begin to notice a difference in revenue. Strong revenue flow is the result of good clinical and business practices. Focus on getting those practices right, and you can expect the revenue to flow.
As we touched on at the top of the article, telehealth is here to stay through this crisis, and perhaps even beyond. Talk to your insurance carriers about using telehealth to re-engage with your patients. Not all practices are equipped with the technology needed to support telehealth systems and workflows. Now is the time to make the change. CMS has expanded access to Medicare telehealth services for a wide range of services. This change is effective for services that started March 6, 2020, and throughout the COVID-19 public health emergency. Private insurers, such as UnitedHealthcare, expanded access to telehealth, virtual care, and digital capabilities as well.
You may also need to educate your patients about the devices they can use for telehealth visits. Take time with patients who may be in your waiting room to walk them through the use of technology for telehealth. You may also want to capture in your database their preferred video platform (such as FaceTime, Zoom, Google Meets, Microsoft Teams, or other). Be sure to train your office staff on this technology as well. Find a person on your team to serve as a lead or go-to resource that can coach your entire team. This moment is a time of learning for practitioners and patients to achieve the most positive outcomes.
Watch for our next article, “Tools to Help Your Practice Thrive and Survive.”
Visit Marcum’s Coronavirus Resource Center for up-to-date information.
The information in this blog is accurate as of June 11, 2020 and is subject to change. Your Marcum tax advisor will keep you posted on updates.