“In preparing for battle I have always found that plans are useless, but planning is indispensable.”

-Dwight D. Eisenhower

Summary: This article is a readiness assessment for medical practices going to war against COVID-19. In it, we will review: Effectively managing cancellations, moving to telehealth care, security readiness, and HIPAA compliance. In addition, we’ll look at how to compassionately care for our team and keep them engaged and healthy, too. Our goal is to help you maximize efficiency and organizational throughput, and minimize revenue loss – all while retaining humanity and empathy for our patients and colleagues.Use your company’s blog posts to opine on current industry topics, humanize your company, and show how your products and services can help people.

Surviving in Lock Down

Make no mistake about it – this is definitely wartime for all medical practices. The following is your readiness assessment and battle plan. I hope it helps shape not only your thinking about what’s coming next, but what to do about it now and how to know what to do next. By no means do I know all the answers, but I put a lot of thought into this and a lot of these practices are reflected in my own practice. Please let me know your thoughts and let’s work as a group to solve this crisis.

By now you’re likely on full lock down, and if you haven’t cancelled elective, non-critical  procedures, it’s time to start cancelling them. If you are like us you are preparing for a long-siege. This is likely going to get worse before it gets better.

This article is one of a two part series. We want to take you down the path we’ve led others down, so you can streamline your organization now and ready yourself for tomorrow.

-Lukasz Kowalczyk MD
CEO and President of ProSkedge

Recognizing the Opportunity Amidst the Crisis

In any crisis, there’s also an opportunity. COVID19 has thrust the need to maximize agility and efficiency into our practices. This mandates a higher level of operational performance. 

For decades, our medical establishment and practices resisted change – largely in response to our regulatory environments and oversight protocols. In the COVID crisis, this is changing literally overnight. 

Opportunity in Uncertainty

Practices face one essential question today: Will these changes be confined to a single, short moment in time, or will they survive; ingrained in a newer, leaner, operational paradigm?  There is a clear opportunity to launch our practices forward in a way we have never before seen, but only if we take it.

Change is hard, but embracing change at this stage means the difference between being operational and failing. Strong, transparent leadership in this dynamic, uncertain time means accepting current volume limitations, embracing new paradigm models of care delivery,  and preparing for the practice of medicine in a post-COVID 19 World. 

What You Need to Know: Business Operations

What does operating in a current COVID 19 world look like? In a word: terrible. Stay-at-home orders and elimination of surgical procedures, although necessary, have gutted clinic and procedure volumes. What can you do? Immediately address these critical topics:

  1. Develop a clear system for managing all cancellations
  2. Operationalize TeleHealth for your practice
  3. Operationalize a remote “Care Force” with secure Protocols

Now is the time to prepare not just for today, but for the weeks or potentially months that follow. How can we increase efficiency and better predict how we’ll ramp up tomorrow? How will the changes we make impact our patients, staff, and overall bottom line?

ProSkedge’s entire purpose is improving efficiency and better patient outcomes at every stage of scheduling, COVID19 or not. We understand the importance of keeping your business operations running and the typical challenges associated with staffing, complicated instructions, patient compliance, and ultimately build profitable practices.

Managing Cancellations

We serve a high risk population, and so many patients have cancelled visits and procedures out of an abundance of caution, while others have been forced due to government orders. If your practice is still open, it is certainly at reduced capacity. How are you capturing cancellations to prepare for rescheduling later? 

We recommend the following best practices: 

  • Be human first. Empathize and validate the patient’s concern. 
  • Reinforce the steps your practice takes to ensure their safety. Capture the cancellation and flag it for reschedule at a later date. 
  • Verify the patient’s contact information so you can reschedule when quarantine and social isolation recommendations lift.
  • Verify the patient’s condition and note any changes since their referral or last visit.
  • Ask if the patient is willing and able to do a telehealth visit should those services be offered.
  • Be human last. Thank the patient for their business and wish them well.

Over the coming weeks, you can use this information to triage your patients as you balance your backlog and new patients. Your CRM system should allow you to export this information into an excel sheet you can sort as needed.

Get Ready for Telehealth

While telemedicine has been available for many years, adoption of a remote care model has remained low. In fact, a 2019 survey found that 66% of Americans would like to use telemedicine, but that only 8% have. When the majority of patients are comfortable with digital and remote tools, why aren’t we redesigning our operations around this technology? In the face of a pandemic that has far-reaching implications to our economy and our small businesses, we no longer have the luxury to ignore remote tools as an option to provide uninterrupted care for patients in need. More importantly, these tools often force an organization to mature their understanding of how work is done and how patient flow works to maximize the efficiency and throughput of the organization. 

Get ready for telemedicine visits

While reimbursement has been a common barrier to offering telemedicine, Medicare has passed timely regulations that allow offices to bill for virtual healthcare as they would for in-person care. Sometimes a crisis is just the catalyst we need to adopt change the market has been ready to make for some time. This is especially important when you’re working with a reduced staff – either due to childcare, illness, or safety. It’s time to leverage remote tools to increase your business efficiency and leverage workers who want to work but can’t in an “in-person only” model. 

OCR Relaxes HIPAA Telemedicine Requirements

Recently, The Health and Human Services Office for Civil Rights relaxed rules on using chat applications for Telemedicine. This statement is essential to understanding the new rules: OCR HIPPA Telemedicine Statement in COVID19

Under this Notice, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency.  Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.”

Your vendor choice will be critical. Keep in mind that almost the ENTIRE U.S. and most of the developed world currently works from home. Bandwidth is strained on video services. Server demand is strained with high volume AV data passing through cable lines. Choose a vendor that can handle the needed upsurge. A few good choices include: 

  • Microsoft Teams can integrate with the scheduling app called Bookings. 
  • GotoMeeting, Zoom, and Microsoft have already integrated HIPAA’s BAAs

Smaller, dedicated Telehealth vendors present a greater risk as they often have smaller server footprints and without sufficient up ramp to meet surging demand. 

Perform a resource survey

Identify Gaps In Your Resources

Before implementing telehealth, perform a deficiency survey of your team, practices and resources. 

  • Who is available to work remotely?
  • Secure equipment: 
    • Video: PC / MAC computers and tablets work best for virtual visits
    • Sound: Microphones and earphones or headsets
  • Engage your IT Vendor to secure company-issued devices that may be taken home. 
  • Ensure everyone who will work from home has a work domain email address (staff should NEVER use a personal email address). TeleHealth visit notifications will pass PHI via email.
  • Prepare your IT support team – ask who is available, what type of support they can provide remotely, and ensure they have an agreed process to share with the team.

You’ll also need to review your security practices with IT and administrator.

  • How quickly can you provide a VPN and data encryption for all remote workers?
  • Assess your BAA agreements with vendors. Are you missing any? Create a plan to fill those gaps. 
  • Determine which staff will work remotely and what tools they’ll need to do so. Conduct a records and platform evaluation. 
  • Develop a plan to transition to platforms that allow you to work together in a HIPAA-compliant manner.

Think through the tools you use today. It’s impossible to do remote business if you’re still using a paper-based scheduling or communications system.  That’s why we think your scheduling department is your first line of defense to moving the business forward. It’s important your tools are efficient, reliable, HIPPA compliant, remote-ready, and (best case scenario) leverage automations that speed up productivity and allow on-boarding of new employees quickly. 

Keeping Business Moving

It is possible to see some patients, via telehealth but you’ll need to define your triage criteria and prepare appropriate billing codes to get patients seen when and how you can.

  • Consider patients you can draw down from hospitals to surgery centers
  • Can you refer during both ramp down (pre-total quarantine) and ramp up (post total quarantine) to keep patients moving?
  • What evaluations can you do by video link?

Take Care of Your Team

(and leverage their skills to ramp up)

First, take time and remember compassion. It’s likely you will face difficult choices in terming some of your staff. Consider the implication of furloughing vs. terming employees. Check on regulations for their ability to file for unemployment. 

Second, from a human or emotional perspective – check in. Are your employees scared right now? What makes them feel that way? Some may be scared of illness, worried about protecting a loved one, concerned about financial security or something you haven’t anticipated. Balance that question with positive ones- what makes your employees feel important or useful? You want to recognize their hard work, but do you know how your employees like to be recognized? 

Check in with your team and managers

Check in with your managers, too. How are they communicating with their team, and is it working for them? Are there tweaks you can make to office protocols to help them succeed? Do they understand where you stand on the rules that need to stay in place (such as HIPAA security) vs. rules that can be relaxed? You might find great continuity solutions by working together. For example, if an employee is having trouble working their usual hours because of childcare, maybe that employee could make patient calls in the late afternoon when the child is napping. What actions and resources will help with communication? 

Know Your Team Resources

From a state of work perspective: Evaluate your operations. Who is available to work and when? Which tasks are mission critical, and therefore must be maintained or must be first to ramp up when quarantine is over? Who is trained on these operations? Where are training and process documentations and who could train others? Are there gaps between current availability or skills? 

Knowing who you have to work, and what they can do is key to your understanding of how you can best utilize your team during this crisis. There are many services that you previously provided that you can’t currently provide – and that labor can be repurposed. At this stage, we want to know  who can work, what kind of work do we need done, and what training we need to give to make our team cross-functional?

Combine what you’ve learned about your team and outline solutions. Perhaps you talked to a surgical tech who is really worried about finances and has plenty of time on their hands; and a scheduler who is overwhelmed balancing the volume of reschedules with caring for her elderly parent who is sick. Could you cross train the surgical tech to relieve some of the pressure on the scheduler? 

Returning to Business

We aren’t sure if quarantine will last weeks or months. We can reasonably predict that ramp up will be slow, not immediate. When stay-at-home orders eventually lift, you will likely face a transition from full quarantine to partial operations. You will need to carefully balance CDC and WHO recommendations, patient needs, and the work capacity your practice needs to cover overhead. Moving forward with a plan will make the balance more effective and give you the small margins you need to be responsive to factors beyond your control.

In this article, we discussed some of the planning steps you can take to go into battle. In our next article, we’ll share tools and checklists to help you make your plans actionable. This is uncharted territory for many offices, but with a proactive plan, and the right tools and resources we can get through this. We’re here to help you navigate the difficult road ahead and make it easier for you. 

Let us know if you have any challenges we haven’t covered here and we’ll update this article to keep it relevant for everyone. Your thoughts, best practices, or additional questions can make a difference in saving lives and getting us all back on track.

Next Week: we will clearly detail the action steps that you need to take to prepare yourself and your staff.