As the leader of a management consulting firm that specializes in independent private medical practices, I’ve had conversations with physicians from across the country on the impact of COVID-19 on their practices. The COVID-19 public health emergency has generated many questions from clients and long hours of work for our consultants.

Topping the list has been how to obtain grant money from Health and Human Services, how to apply and receive a Paycheck Protection Program loan, and how to bill correctly for telehealth services. This article, however, strives to go beyond those questions. The advice this article offers is simple: Do not spend all your time focused on how to get through the business interruption caused by COVID-19. Instead, look toward the return to normal. The most successful practice owners will spend some of their time now, whether their practices are closed or slowly reopening, to create a vision for a new normal.

It is necessary to deal with financial fires when they arise. It would be a mistake, however, to focus on short term emergencies to the exclusion of long-term planning and investments. Here are some actions practices of all sizes can take now to become stronger over the long run.

Be an Excellent Leader for Your Practice

As a physician, the most important thing you can do to ensure the future success of your practice is to be a strong and effective leader. Effective leadership is not just about completing a list of tasks or making wise decisions, but also about the deliberate application of soft skills to connect with and influence the team. With every action and communication, leaders either earn greater loyalty from their staff members or set the stage for future resignations.

Employees want frequent communication and reassurance from their immediate supervisors about policies, plans and expectations. They need consistent communication from owners about the financial condition of the practice and their future job prospects if their hours or compensation are reduced.

When any business is undergoing a crisis, owners may shy away from dialogue with employees for fear they will be asked a question they cannot answer. It is not a sign of weakness to acknowledge none of us know with certainty what the future holds. When leaders display vulnerability, it reassures employees rather than diminishes their confidence.

Physicians are trained to rapidly assess a patient’s condition and formulate a treatment plan, but all recognize that disease prevention outperforms any treatment in terms of cost and efficacy. Like a patient, an organization achieves the best outcomes when leaders take proactive steps to keep it healthy. Practical applications of leadership that keep a medical practice healthy include:

• Define the most critical performance metrics for the practice (volume of new referrals, charges submitted, cash collections, PPE inventory levels). The management team should review the data together at least once a week, and base decisions on reliable, real-time information.
• Conduct brief daily huddles during the most trying period of the crisis. In a practice with less than ten employees, this might be a quick huddle with the physician and all staff members. In a larger practice, the department heads may huddle with their direct reports while the managing partner conducts meetings with other shareholders.
• Carve out frequent time for the leadership team to meet. The managing partner should meet with the individuals responsible for operations, finance, billing, and IT no less than once per week. Do not limit the group meeting to rapid-fire tactical sessions. To achieve success after the pandemic, this group should also set aside time for meetings that emphasize creativity, long-term planning, and collaboration on what will matter most in the future.
• Clean up any bad behaviors quickly. Everyone is under an enormous amount of pressure and even the most even-keeled leaders occasionally lose their temper. If you lash out in frustration, apologize quickly and re-establish rapport. Remember that your staff members are facing their own pressures outside of the office, the specifics of which are likely unbeknownst to you in the workplace.

Document Your Preparedness Efforts before the Next Wave

Few small private practices have written emergency preparedness plans that are robust enough to help the business function effectively during a crisis like we are facing today. While hospitals have volumes of procedures developed in advance to address the various emergency contingencies, less complex businesses tend to learn on the fly by experiencing the pain, undertaking a rapid cycle of problem-solving, and adopting permanent safeguards afterward to prevent future harm from similar events.

COVID-19 could potentially impact businesses episodically over the next two years. Many physicians and other healthcare business leaders have learned a lot during this first wave of COVID-19. The most resilient and successful practices will experience a less negative impact in the future if they invest the time now to evaluate the effectiveness of the actions they’ve taken during this crisis, investigate best practices developed by peers with similar circumstances, and formalize the future game plan now.

Pandemic illness preparedness plans should:

• address what to do in the event a provider or staff member tests positive
• define specialty-specific protocols to triage essential versus non-essential medical care
• include a documented succession plan to ensure business continuity should the managing partner or practice administrator become ill

Practices should also write and distribute policies on business communications to prevent inappropriate public disclosure of protected health information. This is an emotional time for staff, and even well-intentioned decisions to share personal stories on social media can lead to HIPAA violations or other negative publicity for your business.

Direct Staff and Providers to Improve the Practice during Downtime

More than half of practices have not reduced payroll hours during COVID-19, according to data provided by MGMA. While many are expecting their practices to become busy as governments lift stay at home restrictions, it is important to find ways to make beneficial use of staff members during any downtime now or in the future. For practices that have received a Paycheck Protection Program (PPP) loan, one of the program requirements is the reinstatement of furloughed workers. Whether you retained your staff or brought them back early under PPP, you must create a plan for how those staff members can contribute in beneficial ways in exchange for their compensation during times when there are few patients being seen in the clinic.

For all areas of a medical practice, this should be a time for housekeeping. Examples of how to keep underutilized staff engaged include:

• Front desk staff members can review and update the contact information for key referral sources
• Billers can work old denied insurance claims to boost cash flow and clean up aged A/R
• Staff can assess inventory of medical supplies, pulling anything close to expiration for use first as operations are re-established
• Staff can review and update physical asset lists to assist the accounting team
• Teams can utilize videoconferences to hold required radiation safety or QA meetings, annual compliance training, etc.
• Supervisors can catch up on past due performance reviews, or at least prepare the needed documents to conduct the reviews once operations return to normal

Providers should use this time to improve the language in suboptimal EHR report templates, complete quality assurance tasks like peer review, or perform retrospective chart audits for advanced practice providers that require supervision.

Keep Driving Practice Growth and Expansion

Many physicians have put expansion plans on hold. It makes sense to pause and reevaluate the addition of a new provider hire, new office location, or new service line because of financial losses or future uncertainty. For many, COVID-19 has allowed business owners to see their expansion plans under a new light, and have found perhaps they were pursuing the wrong things. Others still, were pursuing expansion plans that they still find valid. There is a distinction between planning and execution. Even if it is necessary to adjust the timeline of growth plans, this is not the time to completely shelf valid strategic growth opportunities and stop planning for the future.

As the impact of COVID-19 continues to unfold, weak organizations will likely become weaker, and stronger organizations will find new opportunities to thrive and gain a competitive advantage. While nobody should view this tragedy as a chance to get ahead through exploitation or unethical business practices, savvy business owners will seize this opportunity to ethically and strategically grow their practices.

As always, any service line addition or expansion project should be preceded by a pro forma and business analysis to ensure that the decision will yield the desired financial result. Making well-informed financial decisions is partly crucial given the broader economic challenges faced by practices at this time.

If your careful analysis reveals that creating new capacity now is important, and the proposed project will require investment in capital equipment, check to see what accommodations manufacturers may be making at this time. Securing a loan from a bank that is overwhelmed servicing SBA loans could be challenging, but you may find alternative lenders are still available and willing to finance projects. In fact, many of these lenders are offering delayed onset of payments and favorable interest rates.

About Teri Yates

Teri Yates is the President of Accountable Physician Advisors, a healthcare management consulting firm that specializes in developing and optimizing performance in office-based endovascular labs, and Accountable Revenue Cycle Solutions, which provides billing services exclusively to physicians in the specialties of vascular surgery, cardiology, and interventional radiology. She is the founder of the website www.protectourdoctors.org, which offers helpful articles and sample policies addressing the legal, financial, and operational concerns involved in running a medical practice during the COVID-19 pandemic.

Photo by Pablo Heimplatz on Unsplash