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  • Considerations for Private Practice Groups in the Age of COVID 

    Author: Stacey Lang

    While the immediate impact of the COVID-19 pandemic on private practice groups is obvious to most, the associated opportunities are perhaps less so. According to a recently released AMA survey, the average number of weekly office visits per provider fell by over 50%. In addition, while physicians, on average experienced a 32% drop in revenue since February, approximately 20% saw drops of 50% or more. Less than 20% of physicians reported no drop in revenue.

    Private practice physicians continue to be impacted well beyond declines in patient volumes. Increased costs related to PPE and other mitigation efforts, staff concerns related to potential COVID-19 exposure, and reduced capacity and access at partner hospitals along with the rise in cases that we are experiencing nationally require more than targeted strategies for practice process change alone.

    Over the past seven months, changes in practice models implemented following the emergence of COVID-19 have been largely reactionary in nature. Given the recent surge in cases and lack of clarity regarding the timing and availability of a safe and effective vaccine, now is the time for private practice providers to evaluate all aspects of the business of medicine as well as the clinical implications related to providing neurosurgical care in this new reality. A thoughtful and methodical approach to practice changes will help to avoid unnecessary costs and re-work resulting from a hastily developed and fragmented plan.

    In many ways, the private practice structure affords a distinct opportunity to address the avalanche of changes experienced in the national health care delivery system. The degree to which decisions can be finalized and substantive change can be accomplished is significantly higher within a private practice structure as compared to an “employed” model. This ability to be nimble and forward thinking without a multi-layered approval process to navigate can be invaluable in ensuring a sustainable and fiscally sound practice for the future.

    What follows are both short-term and long-term considerations for practice restructuring in the COVID-19 era.


    Staffing

    No matter the size of the practice, staffing challenges are often among the most difficult to solve. Now more than ever, is the time to re-evaluate not only the staffing complement but also skill set. Changes in methods of care delivery may mean that even the most skilled staff need to be re-trained or re-deployed to better support practice needs. A migration away from in person visits to telemedicine will require exceptional communication skills for front-line staff. The ability to effectively communicate, and more importantly quickly establish rapport in the absence of a face-to-face encounter is not intuitive for many. The need for a shift in resources can best be determined through a comprehensive review of both back-office and front-office staffing. Factors to consider when performing this evaluation include:

    • Are the medical assistants and other support staff competent in the use of any new technology?
    • Are staff performing adequate pre-appointment screening to ensure that the patient is appropriate for neurosurgical evaluation?
    • Have the appropriate diagnostic studies been performed and are they accessible?
    • Have appropriate screening policies been implemented for staff to reduce the risk of COVID-19 transmission? 
    • Are employee policies in place to address out of state travel and recommended quarantine upon return?
    • Is appropriate PPE available in the office for use by employees?
    • Are all necessary policies and procedures in place to address the integration of any new equipment or other methods to enhance patient access and ensure confidentiality?
    • Is billing staff adequately trained to capture all appropriate charges related to new methods of care delivery?
    • Is the current staffing complement still appropriate given changes in practice patterns and patient expectations?
    • Does a mechanism exist to track and report patient satisfaction scores related to the outpatient experience?

    Facility

    Social distancing requirements, declines in in-person visits, and the potential need to incorporate additional technology into a practice may well mean that facility re-purposing and re-configuration is necessary.

    • Is the existing waiting room space the appropriate size given a likely on-going decrease in face-to-face patient visits?
    • Have seating and access/egress been modified to ensure social distancing requirements?
    • Have barriers been installed in reception and check-out areas to decrease the risk of exposure?
    • Is the space used for telemedicine visits conducive to an effective clinician to patient interaction? (The space is private, quiet, and poses no risk of HIPAA violations.)

    Delays in Surgical Scheduling

    As in all other aspects of daily life, COVID-19 has dramatically affected hospital operations. The reluctance of patients to undergo elective procedures due to the risks of in-hospital exposure continues. In addition, as many health systems across the country limit or even prohibit elective procedures, patients continue to require care. As access improves, a mechanism must be implemented to ensure that patients are prioritized in order of clinical need. The difficulty of this is compounded by, in many cases, delays of several months from the time of initial evaluation to the time that surgery can be scheduled. The following questions related to current practice operations may assist with mitigating any risk associated with patients who have been diagnosed as requiring surgical intervention but who cannot be scheduled for surgery due to outside factors.

    • What mechanism exists to ensure awareness of changes in patient condition that may indicate a need for immediate treatment?
    • How is ongoing patient communication managed? Are regular check-ins scheduled? How are these interactions documented?
    • Is an organized method in place to ensure that these touchpoints and phone calls are billed as appropriate?
    • Have algorithms been developed to assist scheduling staff in recognizing the need for urgent treatment that serves to limit the need for additional direction on a case-by-case basis?
    • Have patient education materials been supplemented/revised to include information related to treatment expectations, revised surgical scheduling guidelines and testing requirements?

    Given the duration of the pandemic thus far, it is difficult to remember what normal practice was and to imagine that we will, at some point, return to normal, albeit a new normal. While the future contains many unknowns, what is certain is that now is the time to prepare for changes that will be permanent—fewer face-to-face interactions, increased use of telemedicine and other technology, associated billing requirements, and perhaps difficult decisions related to long-tenured staff and established space and even hospital relationships. While all certainly present challenges, opportunities also exist. By leveraging the advantages of the private practice model combined with the development of a comprehensive strategy for the future, a forward thinking practice will be well positioned for success in this new world.

    Stacey Lang is Executive Administrator II at the University of Pittsburgh Medical Center and a volunteer with the Neurosurgery Executives’ Resource Value & Education Society (NERVES). NERVES was established to help neurosurgery executives and administrators strengthen their practices. By sharing and collaborating, we enhance the quality of patient care by benchmarking key metrics. Our 200+ members work in various models — from academic to private practice and from hospital-employed to multi-specialty groups.

    References

    [1] AAMA Physician survey details depth of pandemic’s financial impact; Andis Robeznieks, Senior News Writer. https://www.ama-assn.org/practice-management/sustainability/physician-survey-details-depth-pandemic-s-financial-impact. October 28, 2020

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