Medical practices managing patients during the COVID-19 pandemic are being confronted with new and unique operational challenges as many have turned to telemedicine, bringing their services online to continue patient care. Other providers may find it increasingly difficult to continue conducting business in light of wide-scale cancellations of elective procedures and recommendations against in-person office appointments. Unprecedented economic fallout related to the virus outbreak is proving to be another significant concern facing the healthcare system.
In response to this complex issue faced by clinicians across the country, the American Medical Association has compiled a set of recommendations and guidelines on handling the financial and operational repercussions of the outbreak for practice owners and office administrators.
To better adapt practices to current demands and protect them from adverse financial impact at this time, medical professionals should consider the following important variables and strategic responses:
A critical first step to securing the medical practice is to ensure it is protected against COVID-19 related liabilities under business insurance policies. Whether the protection is part of insurance policies will determine the associated risks and help providers make vital business and operational decisions. Experts urge practices to contact their insurance brokers to obtain a complete copy of all insurance policies, understand government emergency orders and decrees, as well as to track losses and expenses incurred during this time for future claims.
Further, practitioners are urged to consult legal counsel for explanations of how they can exercise existing policies and how government orders impact business operations in their state. “You may need to notify professional liability carriers in the event practice providers are called upon to assist with emergency care, including outside of their normal clinical service arrangements,” the AMA adds in its latest guidelines.
In addition, the U.S. Department of Health and Human Services has published a declaration of liability protection against certain medical countermeasures related to COVID-19 which can be accessed here.
Financial Obligations and Contingency Planning
To minimize potential economic risk, practices are encouraged to revise financial plans at this time and ensure their ongoing liquidity; this will hopefully protect those businesses suffering from a loss of clinical revenue due to cancelled procedures, decreasing outpatient visits, and partial or whole closures. It is recommended practices develop a financial contingency plan based on minimum cash flows needed to remain in operation, review existing loan documents and financial covenants, and determine if slowdown of business could trigger a default situation.
Practices should prioritize managing cash to the best extent possible and consider delaying payments of discretionary bonuses as well as other such payments. They may also choose to consider requesting forbearance, forgiveness, or a standstill from lenders and other creditors. Proactive communication with these third-parties can help ensure accommodations are granted during revenue disruptions.
Additionally, clinicians are urged to monitor resources as they become available concerning economic relief packages for business and workers affected by the outbreak; the U.S. Small Business Administration has already begun introducing low-interest loans while other organizations – such as United Way – have created COVID-19 relief funds to provide additional funding.
Current and Future Supply Needs
In light of global shortages of essential medical supplies, such as personal protective equipment and respirators, practices are encouraged to evaluate their current and future supply needs. While a reduction in in-person office visits may decrease the number of interactions requiring the use of such equipment, practices should determine how much cash flow can be devoted to stocking up on essential supplies for the forthcoming months.
“While your business may be interrupted, you may also be called upon to triage patients outside of your normal workflow, so contact your supply vendors and, if necessary, your state and local health authorities to ensure that you are in the queue to receive necessary supplies,” the AMA recommends.
Continuing Business Operations
A growing number of “shelter in place” orders and their extensions may impact the ability of medical practices to continue business operations. However, many of these orders designate healthcare services as essential businesses but publicly available guidance may remain unclear. Practitioners are urged to consult with local counsel to determine the implications of executive orders and how to apply them to their practice.
To further assist clinicians, the AMA provides two non-jurisdiction specific template letters that can be modified to suit the needs of each practice in COVID-19 related circumstances. These templates aim to function as a resource for providers who may encounter questions from authorities or resistance from employees who may not report to work due to “shelter in place” orders.
Regular Communication with Patients
Whether a practice is operating normally or offering digital medical services, it is currently essential to maintain regular communication with patients – in particular, those who may be at-risk of adverse health outcomes as a result of the disruption in healthcare. Reports reveal a silent sub-epidemic caused by COVID-19, that of an increasing number of patients forgoing needed medical care out of fear of contracting the virus in a hospital or medical facility. Patients need to be made aware of the COVID-19 prevention and safety protocols enforced at a practice or other healthcare center and be encouraged to stay in contact with their physicians via telehealth and to come in for in-person care when needed.
Despite interruptions in operations, many practices will still operate remotely. To assist healthcare providers in meeting immediate care needs while working from home, office administrators are encouraged to compile essential resources outlining best telemedicine practices. This includes putting in place methods of maintaining documentation protocols to obtain payments, including processes for collection of accounts, claims submissions, and other activities. More information regarding medical codes and scenario planning has been made available as part of the AMA’s resource hub.
Workflow and Digital Health Tools
To protect staff members, conserve valuable equipment and supplies, and reduce the safety and liability risk to your practice, providers are urged to follow the latest guidance issued by governmental agencies when reviewing scheduled visits and choosing which appointments to postpone, cancel, or proceed with as usual.
Digital tools can assist providers by allowing them to continue conducting business remotely via telehealth services and remote patient monitoring. Following the CMS’ telemedicine toolkit can help physicians and practices utilize these technologies during the COVID-19 outbreak and provide insight into emerging policy changes and practice flexibilities.
Keeping employees updated and informed is essential to managing concerns about health and safety. Practices are encouraged to institute interim guidelines that aim to educate their employees, including outlining circumstances under which they should not report to work, contact information for relevant resources, and specify leave policies related to COVID-19.
Depending on revenue and cash flow challenges, practices may need to furlough or terminate non-essential employees. In these cases, practices should seek legal counsel to understand their obligations, requirements regarding communication of employment status, and identify workflow changes which may be necessary at this time.
While all practices may not be able to sustain each of their employees, healthcare staff is urgently needed at medical facilities across the nation – as such, administrators should identify external opportunities for their furloughed or terminated staff members when possible.
The COVID-19 pandemic has prompted unprecedented policy and regulatory changes affecting the healthcare system nationwide; it is essential for medical professionals to stay current on the latest developments in requirements and afforded flexibilities. As the COVID-19 outbreak continues to evolve, federal guidance and relief efforts are forecasted to offer further support for front-line workers as well as those physicians whose practice has been affected by the pandemic. To access the latest recommendations for practices and physicians navigating patient care at this time, visit our COVID-19 Resource Hub.