• John V. Guiliana, DPM, MS

Coronavirus Blog #3…A Dozen Tasks for Damage Control and Practice Rebuilding


“These past few weeks have been the longest year of our lives!” COVID-19 has changed the core fundamentals of our daily living, our economy, and our businesses. There is no telling what our world will look like when this crisis finally begins to fade, but the one thing that you can bank on is that Darwinian history will repeat itself. As with all crises throughout history, those who remain optimistic and plan will rise to the top, while those who allow the crisis to cause them to recoil and retract emotionally, psychologically, and productively will fall further behind. Don’t let that happen! You have full control over this as long as you remain healthy.

There is no doubt now that our businesses are going to be impacted. Whether by choice or by mandate, it’s unlikely that your patient volume will remain consistent as people finally comply with the CDC guidelines in order to contain this deadly virus. And the impact on the economy is already obvious. The feds fired their bazooka to try to support the economy. Central bank policymakers agreed to lower the Fed's benchmark federal funds rate by a full percentage point to a range of 0% to 0.25% -- where it hovered for years during and after the 2008 financial crisis. But we can’t rely just on quantitative easing to eventually make us whole again. We need to take control of our own destiny.

So this coronavirus blog posting is going to focus on some “back to basics” business strategies that I’m confident you still have control of in order to create damage control and practice rebuilding.

Not since September 11, 2001 have I needed to contemplate, consider, or discuss damage control and practice rebuilding strategies. And if you’re young, it’s highly unlikely that this will be the last time that we need to consider these strategies.

Control what you can control. Rather than focusing on how bad things are, focus on how you can use this time to clean up all the little messes every small business has. Everyone has things they wish they could re-do. Now is the time to make those changes. So here are a dozen things to consider for today and beyond as it pertains to damage control and practice rebuilding:

1. First...your portfolio and financial planning. Don’t panic. I know your numbers look ugly but keep in mind that this is a “self- imposed” global recession. Our nation is DELIBERATELY shutting down to prevent the spread of a virus. This is a different kind of recession. The fundamentals of our economy are strong and unlike 2008, banks are very well capitalized and healthy. This will turn around.

The best time to buy stocks is in a bear market. Any retail store that offers a steep discount makes purchasing very attractive, right? Yet the stock market is the only place on the planet where people get excited to buy as the prices are going up. Think about that! So if you have the liquidity and time horizon, you should be thinking about taking advantage of this and bank on the historic 10% return of the market. But you need to be able to keep your time horizon long. And don’t try to time the bottom. Just jump in.

2. Research telemedicine. To help support your patient volume and production, consider if telemedicine (phone evaluation and management services as well as online evaluation and management services) is something that might benefit your practice and patients. Many payers now cover CPT 99441, 99442, 99443, 99421, 99422, 99423 for patient-initiated remote portal visits. Medicare now also allows for e-visits using the ordinary evaluation and management codes. Be sure to confirm with each payer whether or not they cover these services. Make sure you understand ALL the rules (must be an established patient, must not have seen the patient in the prior 7 days, etc.). Also, be sure to comply with both the documentation requirements as well as HIPAA requirements of telemedicine.

3. Seize this opportunity to get caught up on your charting! I frequently worry about some of my colleagues who are weeks and sometimes months behind in charting. Naturally, this creates both compliance as well as medico-legal issues for the practice. In this digital age of time and date stamping, any auditor or attorney can determine when you created a chart note. Records that are not contemporaneous with the date of service place you in jeopardy. Use this time as an opportunity to right a wrong.

4. Sterilize your office.

5. Re-stock your supplies.

6. Increase your social media presence to create “stickiness” to your practice, even with patients who are stubbornly reluctant to come in for visits long after the crisis resolves.

7. Re-engage your referring physicians. Remind them that you are here to service their patients. Talk about your expanded services, areas of expertise, and don’t forget to discuss your sterilization protocols.

Meet with your partners and staff to examine your clinical protocols. As I discussed in coronavirus blog #2, part of your practice rebuilding strategy should focus on your per visit revenue and visit comprehensiveness.

8. Set up your data management/monitoring system. To prepare for future crises, take this time to decide what data you are going to forever keep your fingers on the pulse of. Here is my suggested list:

9. With numerous conferences being canceled, think about investing your time with online CMEs until things improve.

10. Work out. Daily exercise will help your immune system as well as your stress levels.

11. Seek out the lessons learned from this crisis. Some of the most successful people I know utilize a crisis to look back and examine what they could’ve done better to preclude some of the damages. For example, do you have enough liquidity or do you live on the edge? How is your spending? Do you live at, above, or below your means? I’m sure that you have heard the philosophy that you need to have something set aside for “rainy days”. Well...it’s now pouring. Be honest with yourself and identify what you can learn from this.

12. And above all, keep reminding yourself that this crisis will pass. It’s going to take time. Even as people begin to go out to dinner again, go to the mall, go to sporting events and concerts, the supply chains are going to need time to ramp back up again so there will undoubtedly be some pent up demand. Be patient. Be diligent. Listen to the CDC. And stay healthy. Without health, nothing else in this blog matters.

My partners and I at NEMO Health are here for you….

John

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