• John V. Guiliana, DPM, MS

Coronavirus Blog #5...Yesterday, Today, and Tomorrow


Tomorrow was actually created yesterday... and the day before that as well. In other words, history continues to repeat itself. So while we are all submerged in the anxieties of today’s pandemic, it is essential that we strive to keep things in the proper perspective and begin to prepare for tomorrow.

When faced with a crisis, it’s not uncommon for us to get trapped or “caught up” in the present. We begin to believe that the crisis at hand is not only devastating but a unique situation that no one has ever had to tackle before.

As we continue to try to cope with our social distancing, and as the financial impact of this pandemic becomes more and more real, it’s important to realize how many times this has happened before. And when it happens, there are unfortunately some tragic outcomes. For everyone, life changes temporarily. But our resiliency soon shines and things ALWAYS return to normal. That’s Farr’s Law.

First formulated in 1840 and ignored in ­every epidemic hysteria that followed...including the hysterics involving SARS, Ebola, and now COVID, Farr’s Law has been proven to be a trustworthy map in tracking viral epidemics and pandemics. Farr’s Law of Epidemics states that epidemics tend to rise and fall in a roughly symmetrical pattern or bell-shaped curve. This has already proven true with the COVID data in China, and since I am a firm law-abiding citizen, I am willing to bet that we will soon be following that same pattern. Things will begin to return to normal and this pandemic, as bad as it might seem in the present moment, will be soon be forgotten… just like historical pandemics are no longer on the minds of most people. So if you think this is a unique situation, let’s take a look at what yesterday can teach us about epidemics, pandemics, and our economy. For fun, let’s call it “Fluconomics”, a term that I cannot take credit for.

The connection between epidemics, pandemics and recessions is well documented. To study Fluconomics, all we have to do is step out of the present moment and look to the past. While I am not a fan of identifying the flu by region or ethnicity, in this case I have no choice.

As shown by data from the National Bureau of Economic Research, which tracks economic recessions, the Russian Flu pandemic of 1889-1890 was followed by a recession in 1890 and 1891. The devastating Spanish Flu of 1918 emerged and led to the twin recessions of 1918-1919 and 1920-1921. The Asian flu, from 1957 to 1958, coincided with a dreadful recession during the same years. And then there was the Hong Kong flu of 1968-1969, which preceded the 1969-1970 recession. It’s obvious that we have faced these Fluconomic challenges before and emerged arguably even better. And we will certainly have to face these challenges again.

As I have been pointing out in previous blogs, this particular viral related recession is a bit different. The backbone of our economy was healthy leading into what is now a deliberate shutdown. The Federal Reserve and Central Banks have the resources and policies in place to enable our Fluconomic recovery to be much faster than prior recessions. So now is the time to start preparing to accommodate a surge in demand that your practice will inevitably be facing once this crisis begins to settle down. Here are 7 strategies that you need to start thinking about while you are practicing your social distancing.

1. Motivation and compensation of your employees

The greatest risk of a surge in demand is going to be the strain on your people. While you may see a surge in demand as a growth opportunity, the staff may see it as an overwhelming strain on their time and energy. In the rush to meet demand, you may take it for granted that employees will be willing to work overtime every week or spend extra time training new employees. Be prepared to communicate openly and honestly with them. Ask them for their input on how to solve the challenges of the new demand.

2. Evaluate your processes.

To prepare for a demand surge, and to prevent the need for expensive, margin cutting overtime, take a hard look at your business processes. Automation and outsourcing are the keys to operational efficiency during times of increased demand. Are you using automation to its optimum level? Is this the time to consider outsourcing certain business processes such as your revenue cycle management/billing? Demand necessitates that we stay focus ONLY on our core competencies, which of course is the delivery of high-quality medical care. Outsource anything else that you can.

3. Speak to your suppliers.

You should talk to your suppliers in advance to find out how they might be able to accommodate quicker delivery should you need to order a lot of product quickly.

4. Don’t stop marketing.

Everyone on the planet knows of Coke and Pepsi, yet neither company ever stops marketing. But with increased demand, your marketing is going to need to be more targeted. Decide which group of patients you wish to attract based upon your skills, desires, and the economic margin provided to the practice by that group.

5. Revisit your clinical protocols and be sure to empower your staff to participate in them.

Through proper training, empowerment, and delegation, you will maximize your operational efficiency, enabling you to handle more volume without sacrificing quality.

6. Your current downtime is a perfect opportunity to focus on maximizing the efficiency of your charting process.

According to a recent study performed by the Cerner Corporation, providers now spend an average of 16 minutes per encounter interacting with their EHR. Even worse, providers are spending an average of 11% of their downtime (after hours, weekends, etc.) getting caught up on their chart notes. Look for ways to improve the efficiency of this very important business process. Work on your templates, or even better, investigate opportunities to utilize voice recognition.

7. Keep growth manageable.

During a demand surge, many entrepreneurs rush to expand. They may stock up too much in supplies but later find that the demand for them has passed. Or they may rush to open new locations without doing appropriate market research or ensuring that the staff is fully trained. It’s much better to grow at a manageable rate, even if it means not being able to serve every potential new patient right away. Your reputation is at stake.

Avoid going on a hiring spree just yet. You might do so only to only find out later that you are overstaffed once the demand levels out. Alternatively, investigate if there are “temp agencies” available that may be able to satisfy your human resource needs.

So prepare for tomorrow today. Soon, this pandemic will be a thing of the past. The long-lasting effect of this crisis is undoubtedly going to be the new respect we have for the ordinary flu each year. Perhaps we sort of take the flu for granted?

The official toll of the 2019-2020 normal flu season won't be known for months. The season itself could last until May, and only preliminary estimates will be available until data is finalized. It’s estimated that approximately 60,000 people die each year in the U.S. from the ordinary flu. Globally, the flu kills between 290,000 and 650,000 people each year. I don’t know about you, but I had no idea! So without minimizing this pandemic, COVID-19 has a LONG way to go to approach the numbers of the ordinary flu. If we do the right things, it won’t.

So when you hear statements like “this pandemic is unlike any other crisis we’ve ever experienced in history”, try your best to process the accuracy of that statement correctly. Try your best to keep things in the proper perspective. This is a serious situation, no doubt. But certainly not a unique science fiction nightmare. All you have to do is look back to “yesterday” and realize that we’ve been here before. History repeats itself. We will get through this as well as Fluconomics. Farr’s Law says so!

One final note on something that we should all become consciously aware of. To counteract all of the bad news you are seeing and hearing, start observing how people are helping one another....asking how others are doing... seeing if others need anything...running errands for the elderly, being kinder, etc. Examples of this are everywhere. Sure, we are socially distant now. But the ironic thing is that the very same virus that is keeping us apart is also actually bringing us back together again. Before this crisis, we were being torn apart as a nation. In that regard, I hope history NEVER repeats itself!

From all of us at NEMO Health... Stay calm. Stay healthy. Stay put. And flatten the curve!

For additional blog posts from Dr. Guiliana and NEMO Health, visit https://www.nemohealth.com/blog

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