Many groups had to temporarily shut their doors during the peak of the epidemic, and they did not receive the same level of assistance from financial relief measures as most health systems. So it's unsurprising that when I convened a group of these independent physician executives to discuss Covid-19 this past spring, our conversation focused on how to reopen practices and recover from these volume and revenue losses.
Six months into the epidemic, I spoke with some of these executives again to see where their practices are now. This time, they shared how the prolonged nature of the epidemic is throwing them a new set of curveballs—and how their groups are adapting in response, in some ways for the long-term.
Here's what I learned from talking with these leaders:
1. Human resource and staffing challenges are an imminent threat to independent practices this fall.
One executive put it bluntly when he said that when it comes to Covid-19, "The HR-related issues have been a lot harder than the medicine." Groups are facing three primary HR-related challenges:
- Virtual schooling and an absence of childcare options have the potential to limit revenue this fall. Non-provider staff, such as medical assistants, , LPNs, and RNs, are being forced to take time off or resign to provide child care and virtual schooling. To address this, most groups are expanding their float pools and allowing current full-time staff to transition into the float pool instead of resigning. However, this is a costly measure that still may not provide enough staff to meet pent up patient demand if virtual schooling persists through the fall.
- The new "tale of two workforces" involves remote personnel (administrative staff) and in-person employees (clinical staff). Groups are either developing different policies for each workforce (e.g., who can travel out-of-state, ability to have flexible hours), or handling concerns on a case-by-case basis—neither of which is sustainable or "fair" to staff long term.
- At a time when retaining staff is a top priority, remote work and social distancing are creating new engagement hurdles. Groups are trying to build virtual culture but struggling when previous culture-building activities don't translate from in-person to virtual. They are using virtual town halls and online networking platforms to address this challenge, but still find their culture suffering as a result.
2. Covid-19 clinics are a band-aid on a looming urgent care problem.
Urgent care centers (UCCs) saw volume drops akin to those of EDs during Covid-19's first peak and have not seen those volumes recover. In response, groups are repurposing those sites to conduct Covid-19 testing, administer flu vaccines, or see potential Covid-19 respiratory patients, so they don't lose money on these sites in the short-term.
However, if urgent care volumes remain low for longer periods of time, these reduced urgent care volumes pose a greater threat to primary care sustainability, as many independent groups use their UCCs as a front door to primary care. In the short term, groups should prioritize connecting their Covid-19 clinics with their primary care providers, such as by coupling Covid-19 testing with virtual primary care visits. If volume declines persist, groups may need to find new ways expand their primary care market share and even repurpose their brick-and-mortar UCCs. One group is doing just that by exploring using these sites as transitional care centers.
3. Telehealth should be deployed in ways that benefit the practice—not just to the patient.
Groups are exploring ways to use telehealth to boost practice revenues and increase physician flexibility, not just meet a patient preference. Examples include:
- Shifting visit types with low fee-for-services reimbursement to virtual visits (e.g., diabetes education, nutrition, and behavioral health);
- Rescheduling no-shows as virtual visits to try to recoup lost revenue;
- Using telehealth on evenings and weekends to generate revenue while simultaneously offering physicians more flexibility; and
- Shifting physicians exposed to the novel coronavirus to exclusively virtual visits while they quarantine.
Groups should prioritize opportunities like these that have dual positive impacts on revenue and physician flexibility as the ones they cement longer term.