April 2020

ASCRS NEWS

COVID-19 News you can use
Practices face the COVID-19 crisis


by Liz Hillman Editorial Co-Director

“We’re going to come back out of this on the other side, and we’re going to be better for this experience.”
—Bruce Maller

Businesses across the board are hurting in the COVID-19 crisis. Among them are medical practices, especially those that provide primarily elective procedures, now indefinitely postponed.
Cataract surgery, though the most common outpatient surgical procedure in the U.S. with the ability to improve vision and quality of life, is still considered elective, as are a variety of other ophthalmic procedures.1,2 When the novel coronavirus known as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) became a pandemic, many governing bodies advised or mandated postponement of elective surgeries, bringing everyone from small private practices to large academic ophthalmology departments to a near halt.
Many practice owners might be wondering what they should be doing now, how to not only survive this crisis as a business but, as Bruce Maller said in a late March webinar, come out the other side and thrive.
“What we’re experiencing right now, clearly, it’s unprecedented,” Mr. Maller said in the webinar. While the world is going through uncharted waters, Mr. Maller said he is seeing encouraging signs of “firming” in the marketplace and has been impressed by the energy he is seeing, which he described as a “combination of human ingenuity … as well as basic decency and kindness.”
Mr. Maller described three things practice leaders should focus on now to make it through the COVID-19 crisis.

Protect the integrity of your business

This, Mr. Maller said, includes assembling a core team to develop an action plan and communication strategy; developing a 13-week cash-flow forecast; preserving and locating cash (operating revenue, retained earnings, lines of credit, etc.); aggressively managing cash flow including accounts receivable and accounts payable; communicating with a sense of empathy with landlords, lenders, and vendors; and taking advantage of new legislative initiatives.
The 13-week cash-flow forecast helps establish an understanding of the flow of cash through a business on a daily and then weekly basis. This decision-making tool will help you make critical decisions based on “grounded data points,” Mr. Maller said.
“Once you have the forecast, a sense of where cash is coming from, you’ve got to manage it—and manage it the right way,” Mr. Maller said, adding that you’ve got to be dialed in to your customers, your accounts receivable, and accounts payable.
Mr. Maller also described legislation that could benefit employees and businesses. The Families First Coronavirus Response Act (H.R. 6201) applies to companies with less than 500 employees. Under this act, full-time employees can receive up to 80 hours of paid sick leave and expanded paid childcare leave for reasons related to COVID-19, Mr. Maller explained; there are measures for part-time employees as well. Employers receive 100% credit for this paid leave and associated health insurance costs, as well as no payroll tax liability, and those self-employed receive equivalent credit, Mr. Maller said.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act includes a new Small Business Administration loan program that is designed to encourage employee retention at this time. Any small business with less than 500 employees (including sole proprietors, independent contractors, and self-employed) is eligible to apply for a loan, using it for payroll, debt services, and occupancy-related expenses. The interest rate is set at a maximum of 4%, with requirements including good faith certification. The program, according to Mr. Maller, forgives the amount of the loan you use to keep people employed. He encouraged those applying with qualified local lenders to bring printed pages of the bill with them to the bank, in case the lender isn’t aware of the nuances. It might be a frustrating process, but Mr. Maller said “you have got to be vigilant to get through this process.”

Responsibly manage your team

When Mr. Maller looks at this “horrific” time, he said he knows we are going to get to the other side, and when we do, we’ll need our people, which requires responsible team management now.
Some of this includes a combination of layoffs and furloughs. Furloughs, Mr. Maller said, are generally for non-exempt employees and are temporary with no impact on medical benefits, assuming benefits are currently offered. Furloughs allow you to reduce or entirely cut hours. Furloughs of exempt (salaried) employees would need to include a “no-work” requirement, Mr. Maller said. Salary reductions could be on the table as well, but one needs to make sure to follow the proper rules as it relates to salary reductions for exempt employees.
Mr. Maller said the staffing plan in this type of situation will be fluid and could change from day to day. In the end though, “your mantra needs to be ‘Do no harm as best as possible,’ meaning show compassion,” Mr. Maller said.

Stay connected with patients, colleagues, and strategic partners

“Make sure your patients continue to feel connected to you at a very personal level,” Mr. Maller said.
This could include the use of telemedicine, leveraging of social media, and offering incentives for scheduling future appointments now. Take any opportunity to educate your patients during this time, he said, noting that this education could be about anything.
With colleagues, communicating in a time of crisis can be comforting. Maintaining discussions with strategic partners now might open doors if and when you need them later.
Mr. Maller chooses to see potential in this albeit tragic situation—the potential to ignite opportunity. That opportunity could be alignments, mergers, cost sharing, etc. He said to take time each day to think about what a positive future could be like on the other side of this pandemic.
“We’re going to come back out of this on the other side, and we’re going to be better for this experience,” Mr. Maller said.

About the source

Bruce Maller
Founder, CEO
BSM Consulting
Incline Village, Nevada

References

1. Hall MJ, et al. Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. Natl Health Stat Report. 2017:1–15.
2. Ni W, et al. Impact of cataract surgery on vision-related life performance: the usefulness of Real-Life Vision Test for cataract surgery outcomes evaluation. Eye (Lond). 2015;29:1545–1554.

Contact

Maller: bmaller@BSMCONSULTING.com
 

CMS relief

In light of the financial hardships hitting medical practices, the Centers for Medicare & Medicaid Services (CMS) expanded its accelerated and advance payment program for Medicare participating providers and suppliers. Payments can be requested by hospitals, doctors, durable medical equipment suppliers, and other Medicare Part A and Part B providers and suppliers, under certain qualifying conditions. CMS has said it is accepting and processing these requests immediately, and it anticipates payments being issued within days of request.

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