Closing ophthalmology practices temporarily was a challenge. Now, practices are finding that reopening can be just as challenging and fraught with surprises (some unpleasant, a few positive).
Elizabeth Monroe, a partner and senior consultant at BSM Consulting Group in Phoenix, works with ophthalmic practices to help them through this process. (BSM Consulting offers a number of free resources for practices at their website: bsmconsulting.com/coronavirus-BSM-resources.) Here, she offers some observations and suggestions to help ease the return to a fully functioning operation.
“One of the things we’ve learned over the past couple of weeks is that reopening is affected by many factors,” she says. “One factor is the size of the office. For example, in New York City, office space is at a premium. Physicians with very small offices can only have one or two patients in at a time and still maintain social distancing. They may not be able to see enough patients to allow them to pay their bills. Another factor is the age and overall health of the physicians. In some cases, the age and/or underlying health of the doctors puts them at greater risk of having extreme complications should they contract COVID-19, so they’re just deciding to stay home for a while. Some are deciding to close their practices altogether and retire.
“In addition, some practices recently negotiated contracts with new young associates giving them a high salary and incentives based on production,” she says. “Now, we’re doing a lot of work helping practices revise employment agreements to a point at which it makes sense and is something the new provider can live with.”
Ms. Monroe offers some key pearls for practices as they reopen:
• Make sure you have an in-house supply of PPE. “In fact, many of the states we’re working in require a practice to have a multi-week supply of masks and protective gear in-house,” says Ms. Monroe. “You can’t be depending on some governmental agency to supply you with it.”
• Do trial runs before patients come in. “Have your social distancing plan worked out in advance and try it to make sure it’s workable before patients return,” she advises.
• Review each patient’s condition and decide what level of care is needed. “Identify what each patient needs,” she says. “Then, create a matrix or scheduling tree using this information.”
• Contact patients directly if you want them to come in. “Many patients will be afraid to come in,” Ms. Monroe points out. “If you believe a patient really needs to come in, have the doctor call the patient directly, partly to go over the safety protocol, but also to share with the patient why an in-person visit is important. Practices relying on automated reminders during reopening are seeing a very high no-show rate.”
• Don’t expect all staff to jump at the chance to return. “Many staff members have multiple considerations when coming back,” Ms. Monroe says. “They might be afraid, have child-care issues, or be in a higher risk category and concerned about contracting the virus. Staff members also seem more reluctant to come back if the office’s working environment wasn’t great before COVID. If a practice offers an employee the opportunity to return and the employee doesn’t come back when recalled, document the reason the employee isn’t able to return.”
• Think carefully about who to call back first. “The number one thing you should do is look at your ‘star performers,’ including the people who are able to do multiple things in the office,” says Ms. Monroe. “Those who have the most to offer should be asked back first.
“Ironically, working with a smaller, top-quality staff is helping some practices,” she continues. “Some of them are saying, ‘We’re smaller but mightier.’ It can be an eye-opening experience.”
• Don’t bring everybody back just because you can, even if you want to. “Many practices applied for and received the PPP loan and HHS stimulus money,” says Ms. Monroe. “With those resources it’s tempting to bring all staff members back in, but we suggest that practices analyze how many patients they can safely put through their office. Based on that volume, right-size your staff and cost structure. Don’t recall staff without having work for them to do.”
• Consider paying bonuses so staff won’t earn less if they return. “The stimulus unemployment bonus has been a lifesaver for millions of individuals, but because it wasn’t scaled up or down in response to each state’s unemployment pay rate, it had the unintended side effect of making some people better paid if they’re not working—for a little while, anyway,” says Ms. Monroe. “We’ve been informed that you can use your PPP money for staff bonuses, so some practices have been offering bonuses to staff who are willing to come back. They make sure that staff who return are making at least the same money they’d make if they’d stayed home and collected unemployment.”
• Put together a financial forecast for your practice. “This will give you a clearer picture of the variables you’re dealing with and some idea of when you may be able to get back into the black,” says Ms. Monroe. “This will help you understand what you need to do to sustain your practice in the meantime. If the variables change over time, you can tweak your forecast accordingly.”
• Use telemedicine as much as possible. “This could be particularly helpful with patients fearful of coming in, and practices with limited space,” she points out. “For example, one doctor might be able to work from home doing virtual consults and virtual exams. Some practices are creating hybrid exams in which the patient only comes to the office for diagnostics and testing. The doctor calls the patient later via video chat and provides the results of the testing and comes up with a treatment plan.”
• Don’t call it “telemedicine.” “Many practices we’re working with have indicated that patients don’t respond well to the term ‘telemedicine.’ They often decline an offer to meet over video when that term is used,” Ms. Monroe explains. “When it’s presented as a chance to talk to the doctor or as a ‘virtual examination,’ patients seem more open to trying it.”
• Script the telemedicine pitch for your staff. “The way this option is presented affects how many patients agree to see the doctor this way,” says Ms. Monroe. “Also, patients need to know that there’s a cost involved, just like a normal visit, but that you’ll bill their insurance.”
Ms. Monroe adds one last thing about video interaction with patients. “Physicians are telling us that even if they can’t do all the diagnostic testing or a complete exam by video chat, their patients have been very grateful for being able to do this,” she says. ‘Their patients feel connected to them. They love that the doctor checks in with them. So it’s definitely a plus for many patients.”
Government Sues Regeneron
The U.S. Attorney’s Office in Massachusetts recently announced that the government has filed a civil False Claims Act complaint against drug manufacturer Regeneron Pharmaceuticals.
The complaint alleges that “Regeneron paid tens of millions of dollars in kickbacks for its macular degeneration drug Eylea (aflibercept), using a foundation as a conduit to cover co-pays for Eylea.”
For its part, in a statement Regeneron stated, “There is no merit to the civil complaint filed by the U.S. Attorney for the District of Massachusetts. It is unfortunate that a misguided lawsuit is attempting to assign wrongful intent to entirely legal conduct. Regeneron has fully cooperated with the government’s investigation and will vigorously defend the company’s case.” REVIEW