As providers begin to reopen their practices or resume the full range of services they provided before the COVID-19 pandemic, they will have to consider not only normal clinical care and regulations, but extra precautions needed for staff and patient safety, financial challenges like stimulus loan requirements, employee furloughs, and compliance with local and state regulations.
Guidance is available to help physicians get their practices back up and running safely. The American Medical Association has an expansive guide on its website. The Medical Group Management Association has a checklist with a range of items to consider. Counties and states have created reopening guidance physicians can use to understand local regulations.
It is important that doctors stay abreast of news as much as possible. Organizations like the US Centers for Medicare and Medicaid Services (CMS), the US Department of Health and Human Services (HHS) and the World Health Organization (WHO) all provide up-to-date information on COVID-19 on their websites.
“They should be taking advantage of anything out there to educate themselves and make them better prepared,” said David Zetter, a senior healthcare consultant at Zetter Healthcare Management Consultants in Mechanicsburg, Pennsylvania.
Requirements for opening practices can vary by state or county. Most local governments have been doing a good job communicating what they expect from businesses. But as the nation reopens, many medical practices will be left to figure out exactly how to ensure peoples’ safety.
Practices should try to maintain as much distance as possible between staff and patients, Zetter said. One of his physician clients removed half of the seating in her waiting room. She purchased pagers that are given to patients at check in so they can wait in their cars until their appointment. Examination rooms can be used as waiting spaces in lieu of reception areas. Smart scheduling can help keep a minimal amount of people in reception areas as well.
Zetter also recommends having policies that require staff to wear masks, gowns, and other protective equipment. Practices can provide patients with masks and require that they wear them during appointments. Providers can ensure that staff members are aware of hygiene policies by having guidelines and requirements to follow.
“You don’t have to have written policies in place, but be consistent with communication and oversight of these things,” Zetter said. “Have a checklist and review it with everyone regularly.”
Safe and sound
Ensuring employees feel safe enough to work is also important. If someone does not want to return, providers need to understand their situation and handle them properly.
Zetter said some places have employees who refuse to return because they are worried about getting sick. Staff members who have kids at home and no daycare available may also be unable to come back to work. If someone is called back and will not return, they should sign a refusal of work assignment document, which is a requirement for practices who received Paycheck Protection Program (PPP) funds. Seventy-five percent of the funds are supposed to be used for payroll expenses.
Some employees who are offered their positions back may stay home because they can earn more money on unemployment. This, Zetter said, could be considered unemployment fraud. He recommends documenting it, possibly terminating the employees and advising the state unemployment department of the situation.
“It could be construed as violating unemployment laws if employers don’t properly let the state know that one of their employees should be taken off [after telling them they can return],” Zetter said.
Using federal funds
The federal funds offered to employers during the pandemic have helped keep many workplaces afloat. But Zetter said it is important to understand that some use of the funds are conditional and practices should provide any compliance information promptly. Providers can check on the Health and Human Services’ website to find the terms, conditions, and supporting documentation required for the funds they received.
Practices should be especially wary of money from the Advanced Payment Program, Zetter said. These funds are high-interest (10.25%) loans, so he has advised most of his physician clients to return the money or pay it back immediately, if possible. If providers do not pay it back, Medicare will automatically deduct the funds from reimbursements when they are due, which can create major headaches for accounts receivable.
Providers who received funding through the CARES Act also need a policy that outlines how the funds will managed and accounted for. The policy should include the date the funds were received, a compliance plan, their financial responsibility form, and information on who will be responsible for managing the funds and ensuring compliance. Lenders must validate that whomever they loaned money to complies with the terms under the CARES Act. The Office of Inspector General could be auditing practices, and the chances of an audit could be high.
Managing cash flow
Managing cash flow will be critical over the next few months. Zetter recommends using PPP funds whenever possible. These are grants that do not have to be paid back as long as employers comply with the terms and conditions of the program.
Physicians also need to anticipate that if their practice has been closed or limiting patients, patients might have gone elsewhere for care. “If they think patients are just going to come in when the doors open, they will lose those patients,” Zetter said. “There is no guarantee things will just go back to normal like before. They will need a game plan to get back up and running.”
One effective marketing tool is having staff members call patients to schedule screening or preventive procedures, such as colonoscopies, prostate exams, or other regular tests. “Get them on the phones and schedule as many as you can to build revenue back up,” Zetter said.
Finally, if providers had not been using telemedicine, now is the time to start. Many physicians have been apprehensive about delving into virtual care, but it can help doctors treat patients leery of coming back into an office. Telemedicine can be used for a wide array of patient management services, such as post-surgical follow-up and routine check-ins for patients with chronic diseases.