Covid-19 and it’s economic impact on private practices

Hello,

This is Ken DeRouchie, the editor of The Practice Solution Magazine. On March 11th, I decided that The Practice Solution Magazine needed to shift its focus to the COVID-19 pandemic and how it is effecting private practice. This is still an ongoing research project. 

Between March 11th and March 16th, our researchers interviewed practice owners from throughout the US by phone. We were asking questions regarding the impact that the virus was having on private practices in the Dental, Optometric and Veterinary fields. During that initial 5-day period, most of the practice owners who were interviewed said that they really hadn’t felt a change in business other than a few more cancellations and rescheduled appointments. They did express concern for the future, and uncertainty as to what would happen down the road. Some expressed a concern over the possibility of another big recession, others said that another recession was unlikely. By March 15th this started to change.

On March 15th, The American Veterinary Association sent a message to all of its members stating: 

AVMA is advocating for all veterinary hospitals and ambulatory practices to be considered essential businesses in any situations in which non-essential businesses are asked to close for COVID-19 risk mitigation. Veterinarians and our teams provide important animal and public health surveillance, deliver essential medical care for ill animals, and ensure that only healthy animals enter the food supply.

Veterinary practices can and should defer elective procedures to preserve medical supplies when circumstances call for that. However, veterinarians must also be able to continue to provide medically necessary care for our animal patients, especially during this time when Americans are spending increased time at home with their pets and ensuring the integrity of our food supply is critical. In doing so, and as needed, veterinarians can adapt our approach to ensure an appropriate level of biosecurity that safeguards the health of our animal patients and their owners.

The message goes on to say, “All healthcare professionals need to adopt strategies that will allow them to conserve PPE as much as possible, including veterinarians.

At this point Veterinary practices started offering telemedicine appointments, providing curbside check-ins, cancelling or rescheduling wellness appointments and other non-urgent appointments and started focusing on emergency patients only. 

Source: AVMA Email

On March 16th the American Dental Association made the recommendation for, “dentists [to] postpone elective procedures.” 

Their release states, “The American Dental Association recognizes the unprecedented and extraordinary circumstances dentists and all health care professionals face related to growing concern about COVID-19,” according to the March 16 statement from ADA President Chad P. Gehani. “The ADA is deeply concerned for the health and well-being of the public and the dental team. In order for dentistry to do its part to mitigate the spread of COVID-19, the ADA recommends dentists nationwide postpone elective procedures for the next three weeks. Concentrating on emergency dental care will allow us to care for our emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments.

Source: ADA.ORG

Also released on March 16th is a statement from the California Optometric Association.

“As the facts and situation around COVID-19 (coronavirus) continue to evolve, and in step with Gov. Newsom’s recent Declaration of a State of Emergency, including the call for all seniors over the age of 65 and residents with chronic conditions to self-isolate at home, the California Optometric Association is requesting the cooperation of all California optometrists and issuing the following guidance: The California Optometric Association strongly recommends that optometrists practicing in California voluntarily suspend nonessential or nonurgent optometry care for the next 14 days. As always, it is expected that optometrists will continue to be available as needed for emergency care and services. Optometrists are considered non-essential services under the governor’s guidelines.

COA does not make this request lightly, and it is being done out of an abundance of caution during this historic public health emergency. As health care professionals, we all have a role to play in “flattening the curve” in order to follow sound, scientific public health advice to help limit infections and slow the spread of the virus.

Sincerely,

 Jason Tu, OD

President”

The following day, March 17th, The American Optometric Association released this statement:

The AOA supports the Centers for Disease Control and Prevention (CDC) patient care guidance issued on March 17 and the efforts of state and local authorities as well as state boards of optometry to combat further community spread and a wider outbreak. Also of critical importance are immediate efforts to assure continued access to essential health care, including urgent and emergent care provided by doctors of optometry, and to reduce current and expected burdens on emergency departments.

Doctors of Optometry are frontline physician providers of essential care. Urgent care is defined as medical care provided for illnesses or injuries which require prompt attention but are typically not of such seriousness as to require the services of an emergency room. Emergent care is defined as medical care for conditions requiring prompt medical attention due to a sudden change in the eye or visual health. Based on the immediate health needs of a patient, doctors of optometry can and should use their professional judgment to determine the timing and course of care, including assessing patient expressed urgency, necessary preventative care and the monitoring and refilling of prescriptions.

After these statements were issued, things changed immediately. We’ve continued to interview practice owners all over the country and the answers have changed dramatically. Practice owners are becoming increasingly worried. Some have already had to lay off employees. Most are worried about the long-term impact to the economy, wondering if it’s going to be like the great recession in 2008. Quite a few of the doctors that were interviewed have talked about the increased safety protocols they have put in place, ranging from taking the temperature of everyone (including staff) that enters the practice, and not allowing anyone with a fever inside, to disinfection and sterilization after every appointment. 

One other overwhelming commonality we have heard is the concern for their employees, their patients and their communities and the practice owner’s resolve to help get them through this crisis. 

You, as a doctor and practice owner are a person of vital importance to your community. People look to you, as a medical professional, for answers. You need to remain strong and not play into the panic that is so pervasive in the media. Yes, this is a pandemic and it is a global crisis and there are a lot of people in fear of what’s going on. Educate them. Reinforce the CDC guidelines for safety, i.e.- Clean your hands often, avoid close contact, stay at home if you’re sick, cover coughs and sneezes, wear a facemask if you’re sick, clean and disinfect.

Also, communicate with them and help them get past their fears. It is up to each of us at this critical time in our history to lift each other up, comfort and ease each other. We can all make a difference. Be a beacon of sanity in your area.

As for you as a business owner, there are things you can do to make sure your business survives. For those of you that are taking a big financial hit, the HR 6379 section in the stimulus relief package will help.

Take Responsibility for Families and Workers Act.

Division I- Financial Services

Title 2- Assisting Small Business and Community Institutions

SEC. 202. SMALL BUSINESS FINANCIAL ASSISTANCE PROGRAM.

(a) “In General.—The Secretary of the Treasury shall establish a Small Business Financial Assistance Program under which the Secretary shall provide loans and loan guarantees to small businesses.”

Provisions of the massive stimulus bill which just passed Congress were designed with small business owners like YOU in mind. These elements of the bill make it possible for you to keep your staff fully employed for the next 8 to 10 weeks, even if your practice hours are significantly reduced or you’re shut down entirely.

Other things you should do include: Make sure you update the main page of your website, post on your social media, email lists, texts and let your patients and clients know that you are still open to see emergencies. 

You can also do Telemedicine appointments via skype/zoom or phone.

The AOA published an article on March 11th. In it they state, “The initial legislative response by Congress and President Donald Trump to the COVID-19 public health emergency and localized reports of community spread in the U.S. is a sweeping, $8.3 billion emergency aid package signed into law on March 6. The measure includes funding for lab tests, vaccine research and general outbreak response, including directives aimed at providing physicians with authority and reimbursement mechanisms through Medicare for remote and telehealth services to their patients.”

If you have questions about any of these things or would like advice on where to start or what to do next, you can call me at 800-695-0257 or email me at kderouchie@thepracticesolution.net and we can set up a free, one hour call to talk and I’ll give you some recommendations.

 

Stay vigilant and be safe. 

Sincerely,

Ken DeRouchie

Editor