Ambulatory practices are also working on "re-opening," though they haven't technically been closed. Much of outpatient practice shifted to telehealth during Covid-19. But now, as physician group leaders think about resuming high levels of in-person care, they must grapple with many of the same reopening questions hospitals are facing.
Below, we outline three questions every medical group leader must answer before they begin to reopen their offices.
Question 1: When should I reopen my practices to in-person visits?
Medical group leaders are feeling immense pressure to resume "normal" business. Administrators are (rightfully) focused on regaining lost revenues, and physicians who haven't seen or been directly involved with a Covid-19 surge are eager to get back to work and serve waiting patients.
Making the decision to reopen physician practices requires the same four-part analysis that hospital leaders are making:
- Groups must ensure that their community is past the peak of Covid-19 cases;
- Sites must have the resources and personal protective equipment (PPE) needed to treat Covid-19 patients;
- Practices must be able to test anyone with Covid-19 symptoms, and potentially, all patients requesting a visit; and
- Practices must abide by any state or local restrictions.
Question 2: What services should I prioritize first?
For the foreseeable future, all practices should prioritize being able to intake and triage potential Covid-19 patients and connect them to the appropriate next step.
But beyond Covid-19 patients, medical groups and hospitals should focus on rebooking appointments for their existing backlog of patients. The longer patients wait for an appointment, the more likely they are to switch to a competitor or drop out of the system entirely. In particular, leaders should focus on reengaging patients for the preventive care and chronic condition-related screenings that have fallen in the areas most hit by Covid-19.
Leaders should work through the backlog of patients by balancing three imperatives:
- Clinical need. Leaders must prioritize services based on the urgency from both the clinical perspective and the patient's perspective, keeping in mind all the steps that might fall into the clinical pathway for an episode.
- Financial benefit. The importance of that service to the medical group and partner health system's business.
- Feasibility. Recognizing that each service and each site will have its own barriers to reopening services.
Question 3: How must the operations change at each practice?
It's easy to get bogged down with the obvious strategic questions like when, where, and what services to prioritize first. But the operational policies that need to be implemented or altered may be far more complex.
The way providers interact with patients will be much more complex going forward. Seeing a patient in-person means they will need to be screened for Covid-19 ahead of time. It means that every waiting room will need to be social distancing compliant. Practices will need to change the way they check patients in, navigate them to their room, and check them out in a way that maintains physical distance. Practices will need to create a list of essential, in-person interactions and make sure that is communicated to all staff and referring providers.
As groups reopen and start to work through the backlog of patients, leaders must maximize all available capacity. This is a good time to address outdated scheduling templates, extend hours, deploy APP autonomously, and ensure that care teams are as efficient as possible.
One of the best things that any health care organization can do now is to focus on their internal and external communication. No patient will come in and no provider will come back to work if they feel unsafe. So practices will need to message not only that it is ok to schedule visits, but that the practice has a plan in place for maximizing safety, whether that means maintaining social distancing or proactively offering telehealth where needed.
As leaders prioritize their strategy for reopening, it's important to resist the urge to revert back to majority in-person visits. Groups have made tremendous strides with on demand and planned telehealth visits. As groups think of reopening, a significant portion of visits—particularly planned follow up visits should remain virtual. Carrying the positive momentum of telehealth profitably into the future is an essential step for protecting the resources, tests, and PPE.
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