Business/practice owners are accustomed to facing challenges, but the COVID-19 Pandemic takes the cake. Some say this is a dry run for the end of days or maybe, the universe is trying to tell us something by bringing life as we know it to a screeching halt. As a result, countless numbers of otherwise business savvy individuals are left to cope with a new level of stress; one that can only be caused by uncertainty for the future and a loss of control. It is during these times when the need to focus on what can be controlled and accomplished is greatest.
Aside from taking every precaution to keep your family, staff and patients safe, the smartest thing you can do RIGHT NOW is to start working ON your practice (while you are working IN it less). Begin with your personal office, as one of the simplest ways to increase productivity is to create a clean and organized workspace. Set your smartphone or watch timer for no more than 90 minutes (you can accomplish a lot in a short period of time if you FOCUS) and go through each drawer and every shelf to determine what to keep. Tip: If it’s not useful or beautiful, throw it away or recycle it! Organize by creating and labeling folders (actual and/or digital) and find a “home” for all your “stuff.” Once this is complete, sit down at your nice tidy desk and begin cleaning out/cleaning up your email inbox. Go through from oldest to newest and determine which emails require an actual response, are too late to respond to (trash them or send an apology), are trash or unsubscribe-worthy, or should be archived neatly under labels.
For those who took action after reading “Coping with COVID-19 Part 1” and are feeling the endorphin rush from organizing your workspace, I extend a virtual high five! For those who have yet to find the silver linings in our currently forced slowdown, I encourage you to look just a bit closer. Perhaps cleaning out your desk or sorting emails by label isn’t your idea of a good time, but there are lots of other ways to take advantage of the time you would have spent treating non-urgent patients or performing a bunionectomy (followed by a period of non-compliance).
Let’s say that while compiling documents to submit along with your PPP Loan, you came across some expenses that made you go “hmmm.” Start there by examining big ticket items such as malpractice coverage. Many firms are presently offering reductions in premium due to decreased patient volume. Other insurance coverage like home and auto should be vetted annually for lower rates, additional coverage or deeper discounts for bundling policies. If it has been a while since you asked your agent to do a cost comparison, there’s never a better time than now. The same can be said about companies that you’ve been ordering from for years. Little known fact; Your EHR vendor can most likely provide a “part time provider” discount for less than 100 encounters a month (even if only for a short while, savings is savings). Takeaway: If you don’t ask, you won’t receive.
Now that you have organized your workspace and are starting to discover new methods of managing your expenses (as discussed in “Coping with COVID-19 Parts 1 and 2”) you are on a mission. . . so keep going! Brace yourself for this one though as it could result in an eye-opening experience. Your task is to analyze your accounts receivables (aging situation). If you have a fully integrated EHR (scheduler and charting)/PM (billing)system this will be much easier than if you (or your biller) use a separate billing software (unless you have full access to it). Either way, the following metrics are what you will need to examine.
Begin by running an insurance receivables report (this will show how much has been billed to insurers without response or payment). A true aging report is broken into “buckets” according to how many days charges have been sitting there (0-30, 31-60, 61-90, 91-120, and 121+). The older the bucket, the less likely it is that you will be paid, so focus on that one first. As a general rule, 15% or less of total aging should be in the 121+ bucket. No matter what the situation, it is best to look for old, round numbers (as these claims or individual line items) may have been rejected for a simple reason, overlooked completely (by the insurer or biller) or even been paid at $0 and not adjusted off or appealed. Start there and work backwards.
If you started the process of analyzing your insurance aging and are not liking what you see, you are not alone. After all, in the midst of busy clinic days, keeping up with charting, and putting out metaphorical office fires (prior to the COVID-19 slow down) there never seemed to be enough hours in the day. Now, hours and days are consumed with big picture tasks like maintaining employment for staff, thoroughly screening and only treating patients with urgent conditions, trying to figure out how to bill for Telehealth Services, and for some, realizing that while you were so busy working, the health of your practice was declining rapidly. If this is the case, I suggest “not to cry over spilled milk”, but instead make a plan to minimize the current damage (stop the bleeding) and establish future accountability via checks and balances.
Set up a meeting as soon as possible with your biller. This is most proficiently done via platforms like Zoom where your biller can log in to the PM software, share his/her screen and look up specific patient accounts for you to examine together. Pay attention to how they navigate through as you calmly present several examples of problem accounts (with claims that are more than 120 days old) and ask for an explanation of why there has been no payment, or in the case of an appeal or resubmission, inquire as to what kind and documentation of follow-up has taken place since. Your goal is to let the biller know that you are aware of the less than satisfactory aging situation and that you will now be meeting regularly to discuss problem payers, common reasons for rejections, or basic workflow issues (inaccuracy of data entered by office staff). Meet again in one week’s time to see how much progress has been made.
Congratulations! You have truly started to work on your practice rather than just in it and are beginning to see things in whole new light. By scheduling yourself between 60-90 minutes a day (and actually focusing on the task at hand), your personal workspace is no longer feeling chaotic, your email inbox is continuing to fill but doesn’t feel unmanageable, and after that initial (I’m now paying attention) meeting with your biller (and accepting the calendar invite to meet again next week), you feel a sense of order and control that is unfamiliar but incredibly gratifying. While your biller is working (really working) to get you paid, start looking at each “department” of your practice and ask yourself, “How can we make it better?”
Start at the front desk and dissect the intake process. When was the last time you updated your new patient paperwork? Are patients utilizing your EHR portal, printing forms from your website and completing them at home, or, are most sitting in your reception area filling in page after page while your schedule backs up? Processing new patients is one of the most time-consuming elements of practice so get creative and streamline. Consider implementing a pre-registration intake process similar to those performed prior to surgery.
When was the last time you sat in your reception area (a nicer way to say waiting room) and looked around? What sort of first impressions would you have as a new patient or frequent flyer (established who walks through your door every 9-12 weeks)? Look at the walls, the flooring, the furniture, and maybe even the cobwebs. Do you like what you see, or would a coat of paint or some updated décor make the space feel more inviting? If you hadn’t thrown them out upon recent disinfecting, what types of magazines or other reading materials would have been displayed? Is there any way for patients to know that you treat more than what they presented with (i.e. literature or signage promoting the ancillary services or medical grade products available)?
If there was ever a time to spruce things up and start reinventing your practice, it is now. From initial communication, to patient intake, treatment, and all the way through to check-out, the atmosphere and culture of your practice is reflected in every step. So, start with the aesthetics and then begin to consider what kind of practice you would like to create and which types of patients you would like to treat moving forward.
You may have started peeling wallpaper or pricing out flooring options for your post pandemic reception area makeover. Or, maybe you are taking baby steps and started refreshing the office by replacing your custom orthotics brochure (the one with the couple wearing matching velour track suits) with a 21st century version. Either way, progress is progress, so why not continue your improvements in the treatment area?
Enter one of your exam rooms, sit in the treatment chair and look around. Are the walls in need of a magic eraser or can you still see where that patient with his power wheelchair and a compromised ability to operate it hit the wall? Did the building maintenance man forget to come back and replace the stained ceiling tiles after the office flooded upstairs? Was there an incident with an overly saturated betadine swab stick that might appear to a patient like a scene from Texas Chainsaw Massacre? As they say, the devil is in the details and when it comes to making patients feel comfortable and confident in their choice for care, it is essential. Easy fixes like buffing and shining tile floors, applying some spackle and a fresh coat of pain or reupholstering dated and torn treatment chairs can make all the difference in the world.
In the first seven parts of our “Coping with COVID-19” series, suggestions were provided to make the most of forced down time and to find the silver linings amongst the chaos. These suggestions were directed specifically to physicians/practice owners, as the key to creating positive change is to start at the top. Think about your practice as a large merchant vessel (ship). You are the captain, and your chosen crew can either lead you safely to your final destination or cause the ship to take on water and eventually sink. Get the idea?
Now is the time to bring your crew (team members) up to snuff. To reinforce the hull rather than just patch the holes that will eventually make you sink or have to jump ship. Use your currently reduced clinic hours and staff members “working” from home to hold virtual trainings. Review your most commonly treated conditions, care plans, and all of the office protocols and policies you have been diligently updating for the past few weeks. Encourage all staff members to participate and to spend time reviewing practice related training materials on their own (and don’t be afraid to quiz them). Well-educated team members are an incredibly valuable asset, so invest your time now and reap the rewards later.
No matter where you practice, the effects of COVID-19 have been significant. When positive cases started to present in the U.S. and social distancing measures were introduced, practices started to see a slight decline in volume (as many “routine” care patients began calling to cancel or reschedule). As the pandemic escalated, stay at home orders, followed by cancelation of elective procedures and recommendations to limit face-to-face care caused major financial concerns for physicians and more so for practice owners.
For physicians practicing in heavily populated areas with surging positive cases and deaths, financial concerns soon waned in comparison to keeping patients, staff members and their own families safe. Some decided to close their doors and lay off staff while others reduced clinic days and increased telehealth visits in order to decrease the risk of exposure. For the many who continue to treat patients in person, it is imperative to develop and continue to adapt a practice COVID-19 policy. Review this policy with all staff members, stress the importance of utilizing PPE and practicing universal precautions and check in frequently with each employee to make sure they feel as safe as possible. These are unprecedented times and it has never been more important to keep lines of communication open.