14 – TIPS to Keep Your Practice In Business Despite COVID-19 Pandemic

Decisive action, which is swift, and accomplished through a rapid response process is key to meeting challenges. Employees must be taken into confidence and reassured that a response team has been established, and was in place to assess the situation each day, while the safety of the practice patients, clinicians, and staff was of the highest priority. As administrators, the response team must have the foresight not to put themselves in a situation where issues have to be navigated in real time, for instance if a clinician or patient tests positive for COVID-19, the staff must not fumble on what notification must be prepared and to whom. Given the stringent privacy laws, the situation so arising, can severely jeopardise the day-to-day operations of the practice.

Quite likely, the business insurance policy for COVID-19 , and it’s related liabilities, may not protect or cover the practice. Under the circumstances, business and operational decisions must be implemented after ascertaining the risk elements. Copies of complete insurance policies must be accessed by the practices by contacting their brokers, and actual government emergency orders or decrees must be referenced, depending on the relevance to the operations of the practice. Thorough analysis of losses and expenses must be ascertained, and a record maintained, to prepare a claim.

Options under the existing policy must be exercised in consultation with a legal counsel, in view of the government orders, there would be some restriction that may apply to the business operations of the practice. Professional liability carriers may need to be notified, contingent upon practice providers to be called to assist with emergency care. notwithstanding their practice arrangements being beyond their normal clinical practice. A declaration providing liability protection for certain COVID-19 related activities and medical countermeasures have been issued by the Secretary of the US Department of Health and Human Services.

In the event of less clinical revenue arising out of cancelled elective surgeries and fewer outpatient visits, revised financial plans need to be prepared to ensure ongoing liquidity of the practice. as a whole, or partial closure of practice locations. Estimates of minimum cash flow to stay in business must be developed, as a contingency plan. Pre-anticipating a default situation where existing loan document and financial covenants cannot be discharged, as a result of slow-down of business or collections,

Any cash flow disruptions will entail setting up proactive communication channels with third parties, landlords and creditors, and a reasonable time-frame for fulfilling the obligations can be discussed. Legal counsel can also be sought for the purpose.

Delaying payment of discretionary bonuses or other discretionary payments can be considered in the process of managing cash to the best extent possible. Keeping lenders and creditors informed, and asking for forbearance and forgiveness can also be considered over a period of time. Explore newly emerging economic relief packages, and monitor resources available through them for businesses and workers affected by the outbreak.

Low-interest loans funded by numerous states, counties and municipalities are being administered by the U.S Small Business Administration (SBA). Additional funding for COVID-19 relief fund is also available from other organizations, like the United Way.

Shortages of essential medical supplies including personal protective equipment (PPE) have been created by the pandemic. Cash flow should be devoted to funding supplies for the practice for the months ahead. The number of encounters requiring PPE will be reduced, following a reduction in in-person care.

Possibilities of interruption of the normal workflow of the business may exist in the eventuality of being called upon to triage outside patients. Under the circumstances, supply vendors need to be contacted, and to be in the queue for receiving necessary supplies it is essential to stay in contact with state and local health authorities.

Business operations may likely be impacted following the issue of emergency and shelter in place” orders by many states and localities. Medical practices may be designated as “essential operations” or within “critical infrastructure industries” through these orders. Understanding the underlying policy and its impact to the practice and other businesses which are related is vital, office building of the practice for instance.

Quickly ascertaining the reach of such orders and applying them to the practice is essential. In case publicly available guidance is unclear, and if an essential employee refuses to work, local counsel can be consulted. The employee through a form letter can be notified about essential services that are needed to be provided in jurisdictions where a “shelter in place” order is in existence.

Two non-jurisdiction specific template letters for physician practices have been developed by AMA, these can be modified in consultation with the practice’s legal counsel, to suit the needs of each practice. It is essential for practice employees to have in hand a multistate template letter issued by ‘The Employee Essential Business Certification letter (DOCX)’, in case they are stopped by authorities on the way to work. Another letter titled ‘The Essential Critical Infrastructure Notice letter (DOCX) is meant for practices that need to send it to their employees, highlighting the employee’s employment as an essential service, under the order, it becomes mandatory for them to report for work.

Many businesses, including payors, will be operating remotely due to interrupted or delayed operations. In order to meet the immediate needs of essential resources, while working remotely, the office administrators have to compile a ‘quick guide’ for the staff. In adherence for practices (record keeping etc.) to be consistent with the standard of care, clinical and non-clinical staff will still be required.

Maintaining documents during a full or partial shutdown to obtain payment, including processes for collection of accounts, claims submission and other activities can be considered and put in practice. Resources on CPT reporting (PDF) and scenario planning guidance (PDF) during COVID-19 have been developed by the AMA.

Guidelines have been issued by healthcare payers, and certain government agencies, including the Centers for Medicare & Medicaid Services (CMS) recommending that due to the COVID-19 outbreak, adult elective surgeries and non-essential medical services be delayed. These recommendations need to be referred, when the calendar of the practice is under review for deciding either to reschedule, cancel or proceed with visits and procedures.

This move will protect clinical staff and patients requiring essential services, besides conserving PPE and other supplies. Patient queries will be addressed uniformly, reducing variation, and safety and liability risk of the practice will be greatly reduced.

During the outbreak, digital tools such as telehealth and remote patient monitoring can play a key role enabling a practice to set up functionalities outside of the physical office. It will ensure better safety for the health personnel than an in-office setting. Guide to telemedicine practice to help physician practices utilize telehealth during the COVID-19 pandemic have been developed by the AMA. The guide includes insights on COVID-19 flexibilities for telehealth practice and reimbursement.

State emergency declarations and licensing orders are tracked by The Federation of State Medical Boards. Employees and patients alike can be prepared through clear communication on the merits of using digital health tools.

Workplace safety will alleviate employees concerns about their own health. In the process of assisting employees with making the best health decisions not only for themselves, but also for their families, and ensuring a safe workplace, interim guidelines can be instituted. An advisory for employees should be made available, which details circumstances under which they should not be reporting for work. Any absence for a COVID-19 related reason should be reported to a source identified by the practice. Any COVID-19 related absence should be in accordance with the guidelines provided to them.

An interim Guidance for Businesses and Employers has been released by the U.S Centers for Disease Control and Prevention (CDC) for this information. Likewise, the U.S Office of Personnel Management has provided this guidance for federal employees. It details implementation of COVID-19 related leave and benefits for employees, both federal and state governments have released their own set of guidelines.

Practices at some point in time may need to furlough or terminate non-essential employees, depending on the circumstances of cash flow challenges or external factors that are beyond the control of the practice. The obligations in this regard need to be understood in consultation with a qualified legal counsel. The practice has to understand the legal requirements regarding communication of employment status.In the process of keeping the operations of the practice functional, workflow changes need to be identified in advance.

The COVID-19 pandemic necessitates the presence of healthcare staff and clinicians. Healthcare systems and authorities can be contacted to identify external opportunities available for furloughed or terminated staff.

General guidance on employee furloughs and unemployment benefits have been listed by the US Department of Labor, which has released COVID-19 resources.

The COVID-19 emergency has prompted federal and state governments to waive regulatory hurdles to patient care. In the fast track environs, comprehending the happenings in the external arena of the practice gives a better perspective of managing the commercial aspects of the practice. An administrative staff member can be designated to avoid receiving non-essential email traffic, and signing up for receiving alerts from the Governor’s office, state and local departments of health and payers.

As the status of local authority changes, so do the legal and financial obligations. The practices in the states that have declared a state of emergency, have the right to default on contractual obligations. In addition, patient care will receive top priority, with the government and payers providing the much needed cooperation.

An increased risk of exposure to the virus challenges physicians and other clinical staff that are in the front lines of caring for patients with confirmed or possible infection with COVID-19. The CDC’s Interim Infection Prevention and Control recommendations for Patients with Suspected or Confirmed COVID-19 in Healthcare Settings has listed a set of guidelines for healthcare professionals to follow, and minimise their risk of exposure dealing with COVID-19 patients.

In the process of limiting potential exposure, practices are advised to review any engineering or administrative controls, safe work practices, and/or personal protective equipment.

In the absence of guidance issues determining and evaluating clinically symptomatic persons, triage, and surveillance, infection control and isolation practices, many practices are being tasked with developing clinical protocols following the COVID-19 crises. It’s important for practices to communicate and report to public health authorities, and facilities, it will protect the practice against business and legal risks.