When current news of the novel coronavirus pandemic is constantly changing, it’s natural to feel anxiety about the well-being of your patients, your employees, and your business. However, there are resources available to help your pediatric practice prepare for the future. From managing teleworkers to applying for credit, here are some practical ways to prepare your business for the coming months.
For more information on what your practice can expect financially and clinically in the coming months, be sure to visit the latest webinars from PCC’s Chip Hart and the Pediatric Management Institute’s Paul Vanchiere, who came together to give great advice and sound judgements on what pediatricians can expect from the 2020 COVID-19 pandemic and whose advice informs this article.
For advice and guidance on navigating your practice’s finances, visit the Small Business Administration’s website for more information on disaster relief, the paycheck protection program, and more resources that could be available to you.
Mass Exodus to Telemedicine
Many practices are keeping with federal and state guidelines to stay at home and maintain social distancing to avoid spread of the novel coronavirus. In order to do this, many have constructed telemedicine procedures in record time. If your practice is new to telemedicine or you have questions on procedure, coding, and billing for telehealth or telemedicine, you can consult the following resources:
- The latest COVID-19 and telehealth coding advice from the AAP
- PCC’s list of recommended telemedicine vendors
- Dr. Joe Hagan of Lakeside Pediatrics on performing well visits via telemedicine
- The AAP’s Compendium on Telemedicine
Managing Your Office During a Pandemic
Perhaps no one is fully prepared to work during a time of national crisis. Fortunately, many of the strategies that make your team operate well together in the office during normal operations will help them manage from home, work together under restricted conditions, and do what it takes to provide care to your community safely and effectively.
Instructing Staff to Work from Home
The federal government has instructed non-essential workers to stay at home to contain the spread of the virus. As an essential business, pediatric practices are exempt from this instruction -- however, you will want to consider your practice’s needs and the ability, if any, for staff to work remotely. For advisory guidance on essential business structures, see this page from the Department of Homeland Security. Check with your local jurisdiction for detailed information.
Certain payers will require at least one provider in the office in order to provide certain telemedicine CPTs. Consult your payors to verify their requirements.
First to consider are those staff members at high risk of infection, or those with family members at high risk. This could include staff who have diabetes, who are above age 65, or who have chronic conditions. According to Chip Hart, PCC’s Pediatric Solutions Director, “This is the time for your staff to tell you they’re pregnant (while keeping in mind HIPAA regulations).” He also recommends sending billers home to work, as their physical presence in the office is not crucial to operations and, he says, they can fill in for reception desk staff if they are indisposed.
Scheduling and Location Strategies
Chip also suggests that practices consider whether they can implement an A/B style shift schedule, enabling providers and staff on one shift to work remotely and perform telehealth while the other shift works in the office. This strategy could be invaluable for front line staff should they get sick or need to care for a loved one at home.
Well/sick separation is important for kids and families to feel safe and secure in your office’s physical location. Does your office have multiple locations? Now might be a good time to convert one to treat only “sick” patients and the other for well visits. Paulie Vanchiere of PMI cautions that when the COVID-19 pandemic eases down, pediatricians could very well have a huge number of vaccination work ahead of them, so his advice is to get ahead of it where possible.
If your office doesn’t have multiple locations, you can still implement sick/well locations. Now is the time to utilize any spare space -- ask your landlord if there is any open space in your building, and use it to keep well and sick patients separate. Finally, you can choose to accept well visits at different times of day than sick visits, and disinfect the same waiting room in between these shifts. These precautions will help protect patients and reassure anxious parents hesitant to bring their child to a public space.
Necessary Clinical Precautions
Many offices across the country are taking extraordinary care to protect their vulnerable populations at this time. While at the time of this writing, personal protective equipment (PPE) are in high demand and in some cases, low supply, there are still measures your office should take to protect kids during the pandemic.
- “Curbside” visits: Some offices are treating patients in their cars rather than inside the office.
- In addition, this isolating strategy can allow a nurse to triage patients outside the office.
- Sanitize and organize: It may be time to put away books and toys in the reception area for now. Surfaces that remain should be disinfected regularly.
- Flag any cases of COVID-19. Not sure how to code for it? Check out PCC’s resources here.
- Report cases to local or state health officials. More action items from the AAP Redbook are available.
“If N-95s are in short supply, and an aerosol-generating procedure is not being done, a facemask may be used.” -- Advice from cdc.gov.
Financial Assistance for Pediatric Practices
There are a number of resources for pediatricians and small businesses to utilize in order to make a business plan to protect themselves from the financial impact of the 2020 COVID-19 pandemic.
Chip Hart and Paul Vanchiere recommend practices think carefully about measures such as a line of credit at the bank, paying partners less, and budgeting for low volume for two to three months. “We’ll be the first to admit, we’re not sure what will happen,” Chip explains, but these precautions are important for physician-employers and practice owners
The COVID-19 Stimulus Bill (also known as the 2020 CARES Act) was passed into law on Friday, March 27th, 2020. This Act would provide up to a $10,000 grant to all eligible small businesses under 500 persons and established before February 13th, 2020. This also applies to non-profits and self-employed persons. As a pediatrician, this may include your practice.
Here you can find “The Small Business Owner’s Guide to the CARES Act,” which outlines the different programs for the unique needs your business may need, from covering payroll to information on an SBA loan. The CARES act grant and loan program operates like this: a small business applies for an SBA, including proof that they can pay back the loan, and the SBA advances the business up to $10,000 as an advance, whether the loan is approved or not.
For more information and to learn when these programs will go into effect for your location, please locate and contact your local Small Business Administration district office. You can also check their webpage on COVID-19 guidance for small businesses.
This federal support is being delivered so that crucial businesses like pediatric practices can continue to run and employ members of your community. PCC’s co-founder and CEO John Canning encourages physicians to take advantage of this assistance:
“I encourage you to speak with your accountant or lawyer, or whomever helps you prepare your tax returns, so that you can figure out which of these programs would be best for you and your practice. I also urge you to apply for this support. The government is going to spend the money. As an independent pediatrician, you definitely deserve our country’s support.” -- PCC’s President John Canning.
More Support from PCC
PCC is here to help. From coding, SBA loans, billing, telemedicine procedures, and webinars from Chip and Paul, we’re producing resources regularly so that you can be agile in your business and get paid for it too. Check out PCC’s COVID-19 resources below for more information, and also be sure to visit Chip Hart’s pediatric management blog. You can sign up here for the COVID-19 Business Impact Forum hosted by the Pediatric Management Institute.