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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

Achieving Better Retention and Patient Satisfaction

Thriving successful practices have mastered the challenges of patient and client retention.

A question that needs to be asked, answered and fully understood is, “Where does patient or client retention start?”

The truest and simplest answer is: the point when the patient is procured!

You could say that patient procurement and patient retention are two sides of the same coin.

Let’s delve into this in a bit more detail.

A practice, in essence, has a systematic way of obtaining, onboarding, and treating patients and collecting payment for services rendered.

In amongst all of this is the human element or the patient or client themselves. This is where the complexities of patient retention begin and end.

The Key Points That Determine Patient Retention.

How a clinic addresses the human element is really the crux of succeeding in the challenges of patient retention.

Always keep in mind that underlying retention and patient satisfaction issues are usually issues with service, delivery, and the interaction with the staff.

There are several key points in any practice that determine the outcome of patient retention. This applies to new patients as well as existing patients. These are as follows:

  • Overall Clinic Environment and General Staff Interaction with the Patients
  • Front Desk – Patient Arrival
  • Patient Prep
  • Physician Interaction
  • The Front Desk – Patient Departure
  • Interim Period – The Time After the Patient Leaves Until the Time They Return.
  • Dealing with Patient/Client Upsets

Each of these elements, when properly set up and organized, will lead to a higher degree of patient satisfaction and will result in better retention and better reviews.

In the next article, there will be some tips and strategies to help improve patient retention and treatment satisfaction.

Overall Clinic Environment

Clients/patients know you first by the appearance of your space. Uniforms or staff attire should be impeccable and professional at all times. Waiting areas, procedure spaces and any office visible to newcomers should be kept neat and clean.

Outside the practice, use professionally designed signs and these ought to be kept clean of filth or debris. Restrooms also say something about your practice that may go unspoken but never unnoticed.

Dealing with Upset Patients/Clients

Are there clear strategies, procedures and precise policies in place to deal with people who are upset or dissatisfied with some aspect of the clinic or the service they received?

Is there a person in the clinic who is trained on these policies and designated to handle upset patients/clients?

Staff that come into direct contact with patients and clients should be trained to recognize signs that the person in front of them is not satisfied, and deal with them in accordance with clinic policies. This is particularly important to address before they leaves.

Is there a private place in the clinic where an upset can be addressed? Taking the person aside can make them more likely to open up than if you attempt to deal with the problem in a public space.

Are Surveys Being Used?

Perhaps the single most important tool to improve the patient experience is the survey.

This often overlooked but powerful tool, when used properly, can determine the exact course of action to take to directly improve retention and improve other aspects of the practice.

The use of surveys in a practice can also result in creating better promotional response in the acquisition of new patients. Other beneficial information can be derived from the use of surveys.

New and existing patients should be surveyed.

The actual subject of creating surveys and surveying is a rather involved technology. The entire subject of surveys would be impossible to cover in this article.

Ideally, there should be someone in the clinic who has at least a basic working knowledge of the technology of surveying.

Manners Matter

There is much more to manners than just being polite. This is very important, but there may be other factors to consider on the subject of clinic manners.

Are patients being communicated to in a way that makes them feel understood and acknowledged?

Be Aware of and Sensitive to Personal Beliefs and Concerns

Treat each patient as the unique individual they are. Every patient or client likes to be made to feel special and important. One method of doing this is to have staff review the schedule each day so they can refer to the patient/client by name.

Be sensitive to those who may have particular customs, beliefs and ideas about medicine and treatment. It is always better to ask than to assume! It would be very wise for a practice to survey their patients/clients to discover any important information in this regard.

Develop a culture in the clinic of compassionate care, patient importance and service orientation.

All of these things when done should add up to a patient or client who feels that they are important and appreciated. Doing so, addition to good retention may mean the clinic will also get rave reviews to boot!

Dealing With The Interim Period

In this age of digital advertising & social media, the average American sees 5,000 ads per day (2018). This leads to distractions and plenty of opportunity for competitors to capture your patient or client’s attention between the time they leave your office, and their next scheduled return.

Handle this by encouraging loyalty. Reward referrals, offer a reminder system of texts, email and phone calls, and keep your practice top-of-mind with a social media presence and email newsletters.

If you are a practice owner and would like free help with a particular employment concern or any other management topic, fill out the form on this page, and we will be more than happy to assist you. ^

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If you are a practice owner and would like free help with a particular employment concern or any other management topic, fill out the form below, and we will be more than happy to assist you (highly recommended).










Solution to the Most Distressful Staff Management Problems

I’m sure many of our readers are very familiar with The Practice Solution Magazine’s phone surveys. Our team of surveyors speak with doctors all over the country, 8 hours a day, 5 days a week. Given the nature of your busy schedule, we definitely appreciate it when you take the time to speak with our team. The information that you provide enables us to concentrate on articles of interest to you and your staff.

With that in mind, we have found in our recent surveys that one of the most distressing areas for most doctors is the managing, hiring and controlling of staff. Every person is different, and human interaction within small practices often times can be nerve-racking, volatile and frustrating. You have probably found that not everyone thinks like you do, cares as much about your practice as you do, or is as willing to work extra hours as you do.

We definitely recognize the frustration that can occur with losing an employee whom you have just invested thousands of dollars and hundreds of hours training. One of the most important things that you can do to bolster your practice is to ensure that all of your staff are fully trained and operating on the same page. The optimum team is one that knows what their specific duties are; how to do those functions without any difficulty; can do them without emotional issues getting in the way (in other words, strictly professional); and are aware of what the other staff should be doing.

When your staff are competent work is more efficient, morale is higher and the doctor can just be the doctor instead of the referee or babysitter.

If you implement the suggestions here, you will find at least some of your frustrations disappearing, and you may even get more support from your employees because they will have a better understanding of what you need as the practice owner, which will enable them to become more competent and professional.

It would be nice if employees never made any mistakes and always did a perfect job. But, we are all human, and mistakes or on-the-job errors are part and parcel of running a practice. That raises the question, what do you do when your staff err and how do you correct them? Here are some suggestions.

As part of this overall process you must have written job descriptions and office policies that clearly delineate what tasks a person is responsible for on their job and the overall working guidelines for the office. The reason these are so important is that you use them as part of your correction procedure. Unfortunately, very few practice owners have proper job descriptions and office policies in place.

For starters, if you need to correct a staff member, make sure you review any specific disciplinary policies you have issued so that your actions are consistent with these. For example, if your policy states that theft is an automatic discharge, you would not simply issue a reprimand to someone caught stealing.

The first level of correction is normally directing the staff member’s attention to whatever policy he/she violated, what was not done or what should have been done, all of which is delineated in their job description or in your written policies.

Have the staff member reread the policy and/or job description. Ensure that they understand it and clear up any confusions or misunderstandings. This is usually enough to handle the first offense.

On the second offense the office manager or practice owner should review the situation with the staff member and have them sign a copy of the policy that was violated as an attestation that he/she understands and agrees to the policy and/or job description. We then recommend for you to put a copy of the signed document in the personnel folder of the staff member and give a copy to the staff member to put in their staff binder. One can consider that this constitutes a warning.

On the third offense, we recommend that you do the following: give the employee a written warning, a copy of which goes in their personnel file. Sit down and discuss this situation with them; go over the fact that they’ve been corrected on this twice before; and tell them that, per office policy, continual violations could result in a suspension or dismissal.

Practice owners normally find that this type of action on a third offense either puts a stop to the problem or points out clearly that they have a real problem staff member on their hands and that proper actions, including excellent documentation, will need to be taken in order to suspend or dismiss the staff member for future violations.

What do you do with a staff member that you have corrected three times and who messes up again? You’ve already given them a written warning, discussed that continued violations could result in suspension or dismissal, but you still find them doing it again.

At this point you should check their production record (although you should have done that already as part of correcting earlier violations). Hopefully you have a simple statistical method to keep track of key production metrics for each staff member and the office as a whole so that you can monitor their productivity. If the person is an excellent producer (which is unlikely given that they keep messing up), you might consider the next step to be a suspension without pay for a certain number of days. If the person has a poor production record, dismissal may be in order.

Again, the importance of having proper office policies and job descriptions in place in order to properly deal with staff cannot be overemphasized. You can easily put yourself in a legal quagmire if you attempt to discipline staff without these in place.

We also strongly recommend that you check with a good employment attorney when you are looking at dismissing any problem employee to ensure that all of your legal bases are covered.

If you are a practice owner and would like free help with a particular employment concern or any other management topic, fill out the form  on this page, and we will be more than happy to assist you. Scroll to top

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If you are a practice owner and would like free help with a particular employment concern or any other management topic, fill out the form below, and we will be more than happy to assist you (highly recommended).











Profitable Communication Systems

One of the key elements in running a successful practice is the actual communication level of the practice.

This communication level is not just how people talk to each other. “How” is important, but there is more to it than just that.

It’s also not how many telephones, computers and email addresses the practice has. How they are used is what is important.

Think of communication as a series of systems or channels. These channels consist of not only the methods, but also the importance and reasons for interchanging ideas, information and knowledge.

These ideas, information and knowledge are the elements that keep the staff and patients in tune with what’s going on in the practice as it relates to them.

It is the quality of these communication systems that make or break a practice.

Let’s take a closer look at some of these communication systems.

The first is the methods and quality of how communications are delivered between the staff and the patients at an organizational service level. These communication channels can be in the form of verbal, policy, dispatch or memo, phone, intercom, emails, etc.

The next and maybe the most overlooked aspect of interoffice communication is the job description itself and how well each staff member knows it.

Often overlooked in job descriptions are the elements of what communications are required, necessary, and important relative to the jobs of other staff and the form these communications should take.

Check your office job descriptions and make sure that they include this vital information.

It is also important to include in an office manager’s job description procedures and policies governing the implementing and maintaining of office communications systems.

The question is, how well and how easily can communication be initiated, relayed and received in the practice and with the patients?

It can be proven empirically that the speed, flow and quality of how well communication can be initiated and received will distinguish a well-run and profitable practice from one that is struggling.

Understanding, implementing and maintaining high quality communication systems in a practice is vital to the success of the practice.

Smooth out the communication and watch your practice grow.

Fill out the form  on this page to read the outline on implementing profitable communication systems (highly recommended). Scroll to top

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Fill out the form on this page to read the outline on implementing profitable communication systems (highly recommended).