14 Vital Tips To Keep Your Practice Solvent Despite COVID-19

On March 20, 2020, the American Medical Association (AMA) offered a comprehensive set of resources to help physicians and their staff financially survive during the COVID-19 pandemic.

On March 27, the association presented a comprehensive set of resources for private practice physicians, including a financial checklist for keeping private practice physicians in business.

AMA’s 14 tips to keep your practice solvent are:

1. Implement a process for rapid decision-making and planning
   1. Establish a clear chain of command and rapid response process that is clearly communicated with your employees. Think ahead so you’re not making decision in crisis-mode. Know what your protocol is if someone tests positive for the virus.
2. Understand your insurance coverage
   1. Check to see if your business insurance covers virus related liabilities. Make sure you track your losses and expenses for possible claims. Talk to your lawyer. Government orders may require you to assist in emergency care for which you are not currently covered.
   2. The Secretary of the U.S. Department of Health and Human Services (HHS) has issued a declaration providing liability protection for certain COVID-19 related activities and medical countermeasures.
3. Evaluate ongoing financial obligations
   1. If you specialize in elective surgery, you will likely have less revenue. Revise your financial plans to make sure you can stay liquid. Develop a contingency plan. Get busy talking to your vendors about payments.
4. Make a financial contingency plan
   1. Figure out which discretionary payments you can delay. Ask creditors to hold off. Help your workers with economic relief packages.
   2. The U.S. Small Business Administration (SBA) is administering low-interest loans funded by numerous states, counties and municipalities. Other organizations, like the United Way, have also created COVID-19 relief funds which may help you and your employees.
5. Assess current and future supply needs
   1. Make an inventory of your current medical supplies and how much cash you’ll need to stock up. You may be called to assist other providers. Contact your suppliers to make sure you are in the queue.
6. Understand how to continue business operations
   1. “Shelter in place” orders will impact your business operations. Figure out how your “essential operations” status impacts your tangential businesses like an office building.
   2. If an essential employee refuses to work, check early with your lawyer to understand the reach of “shelter in place” orders. You may need a form letter for your employees explaining the order.
   3. The AMA has developed an Essential Critical Infrastructure Notice letter which you can send to employees describing how the employee’s job is considered an essential service under the order and they should come to work. You can access the letter here.
7. Consolidate administrative resources, including coding tools
   1. You are still going to have to bill for services and will need documentation. Have your administrator compile a guide of essential resources needed for employees working remotely for payer reimbursement. Payers will still need the right codes. You want your remote employees to have the right tools.
   2. Figure out how to maintain documentation during a full or partial shutdown to obtain payment, including processes for collection of accounts, claims submission and other activities.
   3. The AMA has developed resources on CPT reporting and scenario planning guidance during COVID-19. Those resources can be found at the link at the end of this article.
8. Manage workflow
   1. Check your practice’s calendar to be in line with Centers for Medicare and Medicaid Services (CMS) recommendations to hold off elective surgeries.
9. Utilize digital health tools
   1. Use the AMA guide to telemedicine practice to help you utilize telehealth during the pandemic. Make sure you have a clear communication plan with employees and patients about using telehealth.
10. Communicate guidelines for employees
    1. Develop guidelines for your employees to make the best health decisions for themselves. For instance, let employees know under which circumstances you don’t want them to come to work.
    2. The CDC has an Interim Guidance for Businesses and Employers with information in this regard.
11. Plan ahead for employee furloughs
    1. Talk to your lawyer to understand your obligations before you furlough or terminate employees. Check with your local health care systems and authorities to help those employees get placed elsewhere. Help them with unemployment benefits.
12. Stay abreast of new care delivery flexibilities
    1. Government is waiving regulatory hurdles on a daily basis. Assign one staff member to sign up for and disseminate alerts from your governor’s office, state and local departments of health, and payors.
    2. Your legal and financial obligations may change if a state of emergency is declared. The AMA COVID-19 resource center has daily updates on transmittals related to COVID-19.
13. Prepare for exposure incidents
    1. Follow the CDC’s Interim Infection Prevention and Control recommendations for Patients with Suspected or Confirmed COVID-19 in Healthcare Settings. Review what you can do to limit exposure to the virus.
14. Identify and implement COVID-19 specific clinical protocols
    1. Finally, the AMA checklist guide notes that practices are being asked to develop clinical protocols without guidance. “Issues such as how to clinically evaluate symptomatic persons, triage and surveillance, infection control and isolation practices, communication with and reporting to public health authorities, and facility access and security should be top of mind and will help arm your practice against business and legal risks.”

Federal Stimulus Package

The AMA also wants you to know about parts of the new government stimulus bill to help your private practice. The bill includes:

• A new loan product within the Small Business Administration for loans of up to $10 million to help cover payroll and overhead costs, with expanded loan forgiveness criteria. Physician practices with not more than 500 employees may qualify.
• $100 billion in direct financial support to physician practices, hospitals, and other health care providers under the Public Health and Social Services Emergency Fund. This support is for costs of treating COVID-19 patients as well as to ease the financial impact on those who lose revenue due to reductions in other services as a result of the pandemic. Exact eligibility criteria and application process is not yet defined pending implementation.
• Suspension of the 2% Medicare sequester in May through December 2020.
• Limitations on liability for volunteer health care professionals during COVID-19 emergency response.
• A temporary waiver of the face-to-face visit requirement with home dialysis patients.
• Authority for the Secretary of HHS to waive telehealth coverage requirements for new patients during a national emergency. Previous legislation provided flexibility only for established patients seen within the past three years.
• Secretary of HHS will also allow for enhanced use of telehealth under Medicare for federally qualified health centers.

Recommendations To Help Private Practices Navigate Non-Essential Care

Finally, in order to help you preserve staff, personal protection equipment, care supplies, promote patient and staff safety, and keep from overwhelming your local hospital, the AMA offers eight recommendations to help you develop a plan to triage non-urgent patient requests.

The recommendations include telling patients to call first, have a recorded message about self-screening and making a telemedicine visit.