How practices are tackling pandemic staffing

As states lift restrictions and practices ease toward a return to full services, maintaining adequate staffing alongside strict safety measures has been challenging. Here's how some practices are doing it.

A new reality

As many as 97 percent of practices have felt a negative financial impact due to COVID-19, according to a new survey from the Medical Group Management Association (MGMA). Nearly overnight, canceled and postposed appointments and procedures resulted in average patient volume and revenue decreases of 60 percent and 55 percent, respectively. As a result, 48 percent of practices temporarily furloughed staff while 22 percent permanently laid off at least one employee.

"The week of March 16, 2020, will be etched in everyone's memory," says Ewa Matuszewski, CEO of MedNetOne Health Solutions, a physician and healthcare management organization located in Rochester, MI. "Active practices came to a complete standstill. Practice staff were being laid off [as] telehealth became the focus of care delivery."

Those with existing telehealth capabilities had the advantage of pivoting more quickly, retaining staff, a source of revenue and continuity of care in the process. "I was fortunate to have lean staffing pre-COVID-19 and did not have to lay off anyone, though I know this was not the case for many of my colleagues," says Andrew Rosenthal, MD, a board-certified plastic and reconstructive surgeon in Boynton Beach, Fla., and medical director of plastic surgery at Modernizing Medicine, a specialty-specific software company. Rosenthal's in-office patient volume fell 75 percent at one point, but he preserved close to half of pre-COVID patient volume by initiating telehealth visits for consultations and follow-ups and limiting face-to-face appointments for more urgent matters. His staff spent any residual downtime on marketing activities, finetuning practice operations, and reviewing safety protocols.

Andrea Natale, MD, FACC, a board-certified electrophysiologist and executive medical director of the Texas Cardiac Arrhythmia Institute in Austin, maintained 60 percent patient volume during state quarantine orders and avoided staff reductions by largely directing efforts toward proactive measures. "[W]e set up a system to avoid any unnecessary [patient] exposure to personnel, visitors, and other hospital environments, along with dedicated pathways to access electrophysiology services and strictly regulated access of family members and vendors," says Natale.

Staff used questionnaires and widespread serology and PCR testing to screen patients prior to elective procedures. Employees underwent the same screening process. "With this strategy, there were no new infections amongst the patients or the healthcare team members," says Natale. "Seronegative physicians and staff interacted freely in the workplace without using significantly restrictive, expensive, non-conventional protective gears and difficult to implement social distancing rules."

Preparing for reopening

As practices resume services, it is critical that everyone is aware of new guidelines and protocols, especially staff that may have been furloughed. "Physicians will need to rely on their teams to disinfect, monitor and track activities in addition to assisting in the provision of clinical services," says Matuszewski, who developed a COVID-19 playbook that outlines a step-by-step approach for safe practice reopening. "Communication is key [and] training and education of teams is crucial." She recommends having an initial meeting via conference call as well as creating a practice checklist that is available for employees to routinely reference and review.

The sooner this happens, the better, since a backlog of patients awaits. "What many are seeing now is what we predicted: that during the easing of restrictions, we are operating over capacity while still trying to be responsible about spacing out patients," says Rosenthal. "We rebounded to about 125-150 percent of volume post-shutdown as the bubble of patients who couldn't be seen during that time came back into the system."

But legislation has hampered some practices' efforts to recall furloughed employees. The Coronavirus Aid, Relief and Economic Security (CARES) Act expanded unemployment benefits to workers whose hours or jobs were affected by the pandemic, including an additional $600 payment per week. Supplemental initiatives, like the Small Business Administration Paycheck Protection Program, authorized loans to businessowners to cover employee wages and operational expenses. "[A]s the funds hit their checking accounts, practice managers began calling back their staff. [S]taff were often uninterested in returning since they were making more money on unemployment," says Matuszewski. Overcoming this resistance was yet another setback for some practices, slowing their reopening efforts and the provision of timely patient care.

Looking ahead

Now weeks into state quarantine lifts, practices are finding their new normal. "The healthcare industry is shifting to the concept of just-in-time delivery versus having patients waiting on us," says Rosenthal. Telehealth services have become part of daily practice, open office spaces have been reconfigured to minimize prolonged exposure and staff are increasingly instrumental in screening both themselves and patients.

The lessons learned over the past several months highlight the necessity of having plans in place to prevent future disruptions in care and shore up staff and patient safety. "Physicians and their teams will need to move beyond clinical expertise to hone in on some basic business skills, such as a developing a business continuity plan," says Matuszewski. "It's not taught in medical school."

_{About the Author}

_{Steph Weber is an award-winning freelance journalist hailing from the Midwest. She writes about healthcare, human resources and small business.}