This is the fourth 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:

• Part 1: APMA Guide to Loans
  
• Part 2: Accessing Various Forms of Capital for Your Practice
  
• Part 3: Building a Path Forward for Your Podiatry Practice

In a previous article, Building a Path Forward for Your Podiatry Practice, we reviewed steps practice owners can take to emerge successfully from the COVID-19 economic shutdown. In our final article in this series, we move from emergence to a successful return of operations and a healthy cash flow.

Plan for Uncertainty

As the pandemic has clearly reminded us, scaling for growth must include contingency planning. Although businesses were bracing for a potential recession, no one could have predicted a global event of this magnitude. Normally, we would expect that a recession would have limited impact on physician practices, as health care historically has been “recession-proof.” However, due to the shutdown orders, physician practices have been severely impacted.

Additionally, we are unsure of what will happen this fall. Some scientists and medical experts are predicting a reemergence of the virus due to the cold weather and less social distancing. If the virus does reemerge, there is the possibility that state governments may re-impose mandated business and physician practice shutdowns. No matter what happens, seniors who are more susceptible to COVID-19 will likely pull back from needed health-care treatments.

Until a COVID-19 vaccine is approved and readily available to the public, you must move forward without losing sight of the emergency brake, should you need to engage it.

That means it is imperative to develop a plan for your practice with appropriate scenarios, risks, and decisions spelled out. The plan should include alternative scenarios addressing:

• No reemergence of COVID-19
• Moderate reemergence
• Severe reemergence

The plan needs to consider key issues such as:

• Keeping patients and staff safe
• Alternative delivery models, including possible uses of telehealth technology (which should include proper staff and patient training)
• Staffing based on varying patient volumes
• Communication with patients
• Financial alternatives, including possible sources of liquidity (government and bank loans, cash infusions and possible support from CMS)
• Possible advantages of partnering with other physician practices to reduce costs (see Accessing Various Forms of Capital for Your Practice)

Second, you should develop a 13-week rolling cash flow forecast. Your top six costs likely include:

1. Payroll
2. Supplies
3. Rent and utilities
4. Insurance (malpractice)
5. Leases/capital purchases (equipment, buildings, etc.)
6. Debt funding

You may want to work with your business advisor on a cost-containment plan to ensure that you only spend what is necessary. Once you procure the supplies you need to reopen, reexamine your supplier arrangements going forward. Which supplies do you need to stock now, and for how long? Contact your suppliers if you need to restructure your payment arrangements. Also, examine the timing of your purchases. With possible reduced consumption of supplies, if any of your materials are on auto-reorder, you will need to review and adjust any timing of deliveries and manage the consumption of materials. You will also need to review any supplies that have expiration dates or need special environments for storage (think cold storage). If your practice has been on hiatus or slowdown, do you need to dispose of expired supplies or medications?

Remain Visible

Next, develop a marketing communications plan to engage your patients. We are in a recession, and many of your patients have been adversely affected by the pandemic. Some may be reluctant to schedule appointments because of cost or safety concerns. Assure them of the CDC safety protocols you have in place in every communication.

Due to how early in the year the pandemic started, some patients may still have co-pays or deductibles to meet. You may need to work with your finance manager to establish alternative payment plans with your patients to get them back in the office for the visits they need. Now would be a good time to speak with your bank about low-cost funding and loan availability to provide liquidity to your practice and support extended payments by your patients.

Remember, you want to remain visible to retain patients and stay top-of-mind for when they are ready to schedule. Consider using videos to educate patients and share updates. Videos are inexpensive to produce and help show you as the personable and helpful medical professional who you are.

While patients are in your waiting room, use any videos playing in the waiting room to educate them about telehealth, safety procedures, alternative payment plans, and the importance of current patient contact information (cell phone numbers, email, and alternative contacts) to help keep them up to date. If you are marketing through social media, use the videos in your waiting room to direct them to your social media channels, your website, and upcoming webinars.

Don’t forget to schedule goodwill calls to patients who have cancelled appointments. Remember that their lives have been disrupted, and a telephone call conveys your concern and interest in their long-term care. Make sure those making these goodwill calls are conveying a sense of empathy and concern for the patients. As you scale your practice, additional time and training should be spent on educating all who interact with patients on patient empathy and creating a strong patient experience.

Have a Plan for Absorbing Postponed Appointments

The good news is that your patients will eventually be ready to reschedule appointments, procedures, and ongoing care. However, if you suddenly have an influx of patients calling to resume care, are you staffed to meet their needs? As part of your reemergence strategy, you will need a defined plan to absorb rescheduled patient volume in the coming months. For example, how will you prioritize elective surgery and chronic patient care? Be sure to balance patient load with staff capacity and scale up slowly. Remember, patients will be looking to you to offer guidance about rescheduling appointments.

Some of your patients may have the added complexity of needing to schedule visits with a number of other physicians simultaneously. This situation can be overwhelming for them. Patience and compassion are important. In addition, some patients may have transportation challenges. If you have the ability to assist or guide patients to transport services, these actions will increase your patients’ affinity for your practice.

Summary

With a focus on business continuity in a COVID-19 environment, your practice must continue to implement new safety standards and frequently review your contingency plans. If you thoughtfully approach planning for your revenue goals and patient care, you will not only survive the pandemic—you will be poised for long-term success.

Coronavirus Resource Center

Do you have more questions about the impact of the coronavirus on your business? Call or email Maryann Czarnota, CPA, at 847-282-6525 or David Mustin, MBA, at 440-459-5755.

Visit Marcum’s Coronavirus Resource Center for up-to-date information.