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Key Steps to Restarting Physician Practices

Jun 9, 2020

In this podcast, Bert Orlov, a Director in EisnerAmper’s Health Care Services Group, discusses the key steps in restarting physician practices post-pandemic. Bert covers how to make patients more comfortable in coming back to physician offices, ways to minimize risk, how technology and partnerships can help, and practice financial management in the new normal.


Dave Plaskow: Hello, and welcome to the EisnerAmper podcast series. Today, we have Bert Orlov, a director in Eisenhower's healthcare services group. We'll discuss the key steps in restarting physician practices during and post COVID-19. Hey, Bert. Thanks for joining us.
Bert Orlov: Well, thank you so much, David. It's my pleasure. And it's a topic near and dear to my heart, then more importantly, near and dear to my clients' hearts.

DP: Well, I think a good place to start, Bert, is give us your thoughts on how practices will have to prepare for a reopening.
BO: Always happy to discuss this critical topic that we've already begun working on with so many of our physician and faculty practice clients to really think ahead to how operations will work in a, if you will, post-COVID world. We think that it is important to take the time, as things are just ramping up, to plan and organize operationally, financially, and of course, clinically and patient safety now, rather than just thinking that it's going to be the way it used to be. This is the chance for a practice to really plan out what the next three to six months are likely to look like while understanding that there's going to be an evolution in the way patients feel comfortable, what the guidance from the CDC is going to look like, and how we move forward and progress toward a new normal, which will look different than the old normal.

To paraphrase, Winston Churchill, we never want to waste a crisis. So, what I mean by that for our practice clients is that if there have been operational or clinical issues that have been not working optimally, fix them during this reopening period, you may not get this time to step back and think with lower volume about how to make things work better for the practice as a business, and that the patient need to be safe and confident.
DP: Okay. Now, certainly any organization can say, "Okay, folks, we're open. We're open for business." But it's only going to work if people come to that business. So, how can you make patients more comfortable coming back to physicians’ offices? And the flip side of that is, what proactively can those physicians’ offices do to minimize risks for patients?
BO: David, that is such a central and critical question for all practices today. First, to understand that, I'd like to add one element, which is that safety, social distancing, infection control, et cetera, also start with the providers themselves and the staff. If they're not feeling confident, they're not going to convey confidence to patients, and you won't have a good story to tell to the patients about what you're doing. We think that there are a number of key levers that can be deployed, how to deal with patients waiting, how to manage schedules and how to use or not use telehealth as parts of it. So, to elaborate a little bit, some practices are going to face different options than others, depending on how big they are, whether they're in the middle of a big city or they're in the middle of freestanding site in the middle of a big parking lot.

That's going to shape each individual practices, strategies, but adjusting the waiting room, making for social distancing, putting plexiglass barriers between the front desk staff and the patients to minimize the risk of infection sharing becomes, I think, an important point. For suburban practices, you may be able to let patients wait in their cars if a practice is moving more into telehealth. You could offset that in the schedule so that there are fewer people likely to be in the waiting room at any given time. And that drives to a second point, which is the importance of being flexible about the schedule. Patients may want earlier or later. They will need comfort that there aren't going to be tons of sick people sitting right next to them in a waiting room. And that's going to drive a need to adjust staffing schedules, both by the clinicians and administration. So, staggered schedules, expanded schedules, and the interweaving of telehealth are all going to be key factors, as well as making sure, ultimately, to communicate your plans very clearly to your patients so they feel comfortable.
DP: Okay. Now, telehealth really seems to be having its moment in the sun. How does telehealth fit into all of this?
BO: Great question, Dave. Telehealth has been gestating for a decade, and with COVID it is out and here and it's clearly going to remain an important tool in health care delivery going forward. Many practices are going to need to continue telehealth because some patients are simply going to be too nervous to come back to the office. In other words, there may be opportunities for some practices to reach out to wider groups of patients with different services. To plug ourselves for a moment, we'd encourage you to listen to our podcast about telehealth, because there's so much in that universe to explore.
DP: Now, are there ways that practices can leverage partnerships to enhance the process?
Bert Orlov: Absolutely. And partnerships can mean a number of things. I'm going to focus here on "elective diagnostics, procedures, surgeries" that had been deferred because of the pandemic. And so we for specialty practices that rely substantially on such procedures for their revenues. Getting patients back in is absolutely critical economically, and that means that it's got to be done with a special sensitivity to safety and infection control, because patients would be even more exposed. So, we believe that every practice needs to coordinate with its partners, whether it's AFCs or hospitals or radiology centers, as well as its referring doctors, and make sure they understand how this is going to work and really establish a plan. Then move on to really looking at all of the patients who have deferred procedures or diagnostics or surgeries, think about the clinical criteria,, and target communications and outreach to those patients to say, "Hey, you put this off, we called it elective." Or, "The compliance rule said it was elective. But it's really important and you need to have this. And then here's what we're going to do to make sure you are safe."
BO: I'll give just an example. If a procedure being done at an ambulatory surgery center, to be able to send that information and explain that everyone coming into the centers has a temperature check and the staff are tested for COVID once a week and there'll be appropriate social distancing, and there'll be fewer cases, so you won't be recovering in a recovery bay with somebody right next to you, be able to communicate all of that so that the patients feel comfortable saying, "Yeah. I need to do this. Let's do it." On the operational side, coming back to that concept, you introduced partnerships, is working with your AFCs or diagnostic partners or hospital partners to create if not formal block time, then scheduling in groups, because for practices as a reopening, we can't run back and forth and do a case at 8:00 AM, and then another one at 11:30. You've got to put them together. So operationally, the doctors can be efficient. That principle hasn't changed, but the timelines may look a little different as we see practices reopening.
DP: Obviously, these practices are in business to generate revenue, and certainly during this pandemic liquidity is the name of the game. How can these practices put themselves in a better financial management and revenue-generating position?
BO: We believe that there are three core elements to strong financial management. One is the ongoing focus on the revenue cycle. You've got to get in every penny that you can. Two is to develop a projection so that your costs and your staffing are aligned with your anticipated patient flow, and be prepared to adjust that as patients do or don't come back sooner faster or slower, or as you see a different balance between onsite visits and telehealth.

The third thing is to be aggressive about complying with the rules and time limits of any federal loan programs in order to maximize forgiveness. If loans have a repayment date or trigger date, make sure you're on top of those. If a practice has drawn on its own lines of credit, be prepared and understand how to best manage those. If there's an annual payoff required, or however it's structured, utilize the resources and tying it to the idea of the development of a financial plan to anticipate cash flow crunch times, how long is it going to take before money starts flowing in because of the nature of revenue cycle, et cetera, you really want to put those pieces together so that a practice doesn't make the mistake of repaying all of its debt and then a month later finding, "Wow, no revenue has come in, and we don't have enough to cover payroll." So, you need to balance those factors to bring them together to be effective financial managers.
DP:Okay. All of these sound like great ideas, Bert, but you also have to communicate that to your patients, to your partners, to third-party service providers. Give us some tips for getting the word out there to those folks.
BO: Absolutely correct, David. Outreach first to existing patients bring back what you've had, that is step number one. You know your patients, your patients know you. Anybody who's missed a procedure or an appointment or anything of that sort, go back to them. Anybody who should have been coming in for routine, go back to them, and as we discussed earlier, explain how you're going to keep themselves safe and comfortable. Explain if you're going to be offering telehealth, how that's an option and how that will work. Communicate, communicate, communicate. And as you said, you also need to work with and communicate with your partners in AFC, a hospital referring doctors communicate to them, all the things that you're doing. I think communicate isn't just once, it's multiple times, because things will be changing and evolving.

As we said, telehealth is also an important point, not only for your current population, but because for some practices, they may be able to reach a larger market than they have historically, because telehealth now makes it feel more comfortable, more normal, if you will, to conduct a visit that way. For specialists particularly, or people in rural area, there may be some real market expansion opportunities, but we tend to think of that as going second after you've reestablished your base of patient. But I think at the end of the day, there's no such thing as over-communication
DP: Well, Bert, thanks for bringing us up to speed on these key steps, where restarting a physician practice.
BO: My pleasure.
DP:And thank you for listening to the EisnerAmper podcast series. Join us for our next EisnerAmper podcast when we get down to business.

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Bert Orlov

Mr. Orlov is a Managing Director in the Health Care Consulting Group with experience as a management consultant specializing in strategy, transactions, operations and project management for physician groups, hospital systems, and not-for-profits.

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