Considerations for Adjusting Operations of a Pediatric Practice during the COVID-19 Pandemic

The COVID-19 pandemic is a national level event that has changed the usual daily lives of almost all Americans. The first full week of the impact of pandemic started last week (week of 3/16/20). After reflecting on the week and reviewing some objective data from Pediatric Practices that we work with, I wanted to share some information to help Pediatric Practice leaders and owners evaluate practice operations during this uncertain time. While many pediatric practice leaders/owners have already implemented the basic framework listed below, my hope is that this helps some pediatric practice leaders develop a basic framework and the content will inspire others to share additional approaches and information.

Disclaimer: This is a background document to help practice leaders and owners identify the strategic questions when evaluating changes to operations of their Pediatric practice. This document is not meant as legal or medical advice.

Should the Practice stay open?
A few governors are requiring the closing of all non life-sustaining businesses. Pediatric Practices are considered “Life-Sustaining” businesses and can stay open. Patients and families in the community rely on Pediatric practices as the medical home.

How should we engage patients during the pandemic while schools are closed and many parents are working from home or taking time off from work?
Based on early data & feedback (1st week) from parents, the leader(s) of each pediatric practice should consider the following options for treating patients at their Pediatric practice:
• Well Visits in the office (priority are patients less than 5 years of age with their vaccines).
• Sick Visits in the office (consider phone triage for appropriate asthma, allergies, and patients in need for testing such as strep testing).
• TeleHealth visits (some allergies, respiratory, ADHD follow-up, and other follow-up visits)

What hours should the practice be open during school/work closings?
If there is school and work closing in your county/state, the practice can probably reduce the hours available in the office
• Consider being open from 9-6, 9-5 or other reduction in the practice schedule since many families are home and available during the day.
• Consider removing all walk-ins and triage all practice patients per a standard triage (recommend refer to another post or article or resource such as Clear Triage).
• Consider seeing sick in the AM and the well visits in PM or using one office for Sick patients and the other for well patients.
• Consider having all on-call providers take call with telehealth until 10 pm.

Should we ‘lay off’ or reduce time to part time for any staff (front desk, MA/Nurse) as well as Pediatricians or other Pediatric Providers?
Based on the hours available at the practice and predicted work load, a good business decision is to align the staff resources to the practice needs.
• Evaluate the core staff needed for Pediatric providers. This might mean that the pediatric providers move to ¾ or ½ time for the next few weeks.
• Based on the Pediatric providers work schedule, identify the needed hours/staff for Medical Assistants and front desk.
• It is anticipated that partners of the Pediatric practice will need to dramatically decrease their salaries and/or draw from the practice in the next few months.

What was the average change in visits last week compared to previous two-week average?
There are many variables that can impact a Pediatric practice visits to this Pandemic including area of the country, number of COVID-19 cases in the area, the Pediatric Practice approach with treating patients as well as some other factors. Last week, the average practice we work with had a 42% reduction in weekly visits as compared to the weekly average for the previous two weeks. While the national average might be different than this, recommend Pediatric practice leaders to evaluate the change in average visits at their Pediatric practice closely and make appropriate adjustments.

Based on this early data, what adjustments should we consider related to staffing the practice?
• If the average practice is close to capacity and the practice had a 40% reduction in visit volume last week as compared to the average volume per week the previous few weeks, the practice probably needs about 40% less hours/staff time to manage the patient volume.
• The practice workload from the first week is probably the best forecast of the anticipated work load the next 2-3 weeks (note that there is no historical data on a national pandemic so this limited data is better than no data).
• Evaluate what level of staffing your practice needs over the next 3 weeks and consider reducing provider/staff time by 20-40% as well as consider the pediatric provider on call to conduct calls via telehealth.
• A choice is to ask providers/staff to take a temporary pay cut (e.g. ¾ time if currently full time) for the next 2-3 weeks.

While there are other operational considerations and learnings over the next few weeks, I hope this limited information will help confirm your Pediatric practice planning during this challenging time.

Please note that this list is a starting point and limited to the initial feedback we have received from the Pediatric practices that we work during the first few days of the COVID-19 operational challenges experienced by Pediatric groups. There is much more that we all will learn over the next few weeks so please share some of your initial operational experiences and changes due COVID-19.

Your patients, parents and staff depend on your leadership during this time. While challenging times are difficult these are the moments that we grow and learn to improve the pediatric practice approach and patient care.


Thanks for shaing your thoughts…some practices have decided to go with well visits in the morning and sick in the afternoon under the theory that things will be a bit “cleaner” in the morning versus after lunch…practices wipe down all surfaces at the end of the day and then again before they start seeing well checks the next mornig…

I’ll be sharing some national data publicly (and here) shortly - I think the average charge posting lag is a little high right now as people focus on other aspects of their businesses and figure out how to bill phone and video codes. By Tue or Wed next week I think we can start trusting things through the weekend.

One trend that’s quite clear is that sick visits have decreased a lot faster than well visits. In addition to checking visit volume, I think we need to watch charge/payment trends. The visit rate naturally decreases this time of year but the revenue stays the same or grows a little as the focus turns to well visits naturally.

Thanks Chip and agree with your thoughts. Will be very interesting to see the national data. We show a range of 25% to 61% reduction in total visit volume from the previous two week average. Many practices were trying to adjust last week so will be very interesting to see what occurs this week.

Thanks Paulie for the feedback and your leadership to setup this site. I updated the post for well visits to be in the AM and sick in the PM. Look forward to others sharing their experiences, additional information and suggestions. Best, Ken

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Can you measure in terms of charges? We all realize that it’s PAYMENTS that matter the most, but we won’t know the real impact there for 2-6 weeks, depending.

Practices are still closing charts so we have an idea of visits at this point but not charges. Anticipate the average revenue per visit will decrease due to the increase in teleMedicine visits last week.

yes this is what we have done and parents seem to really like it, we were worried parents with sick kids would be upset with having to wait till early afternoon, but without school/work, it seems to be fine so far.

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Behind the scenes…

3 things I did today to position my private practice to thrive in spite of the Coronavirus pandemic.

Would have been way too much to type so I figured I would shoot a quick video for you :blush:


Bravo! Keep them coming, please!

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Thanks Chip, will do!

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Thanks for sharing your approach Dr. Una.

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Great video thanks for posting.

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Thanks - great video.

What are your thoughts on adjusting partner compensation models during this crisis? Would love to hear more specifics on this in the next webinar.

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Every practice owner should be prepared to go without personal revenue for some period of time (it could be measured in months). I’m going to share data shortly, but it’s still a little soon to really understand the cash hit - but if every practice’s revenue is off by 25%, that’s a good rule of thumb for what an owner will take home.

In other words, if you and your partners haven’t had this discussion yet, make it a priority today.

I’ll defer to @Chip, he’s the expert on that. Having said that, if the revenue decreases, what the partners take home will have to decrease. Partners are there to share profits and risk.

I recorded a three-part series on my podcast about how to navigate the times we are in. This is geared towards physician entrepreneurs in general not necessarily private practice but you’ll find it very valuable.

  1. How to be calm in the midst of chaos

  2. Your biggest weapon in the midst of chaos

  3. Three questions every entrepreneur must ask in the time of chaos


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Although there will clearly be exceptions, any practice owner who expects to get full (or any) payment over the next 2-3 months is dangerously naive.

Of course, I think most people here know that. The real issue is for practices with a range of partners, some of who are/were expecting to retire in the near future. Big buyouts are going to be impossible for many right now. Practice valuations are essentially useless. Some partners who everyone planned to leave this summer will see them flying back (sometimes good, often bad). Etc.

If you haven’t had a discussion about compensation with your partners already, make it a priority.

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thank you for your nimble platform for pediatricians to crowdsource in real time…i would love the big thinkers to start creating an “ASK LIST”—while we are busy getting ready for our practices to take a financial hit…we need to on a state and federal level start thinking about our primary care needs…can you all float this concept–including the heads of bigger practices and national AAP/ state AAP—we will need to be thinking about our fixed costs and how to reduce them----vaccine programs like VFC–but for all perhaps for X amount of time…so as to reduce the inpt practices over head// how do we reduce our malpractice costs–could there be a national act for creating an umbrella ins for all physicians–for X amount of time so as to reduce our overhead// would the private payers think about a double payment schedule–not just parity–for TM----so as to reallocate some of their funds RIGHT NOW// could we think about an outcome incentive award for primary care to offered NOW by private payers for being open, for providing care , providing TM NOW–rather than in the aftermath==a deployment of funds (federal/ state AND private monies) for PREVENTION// thoughts about funding hazard pay to physicians NOW as we are footsoldiers in this biologic war-----do the US ask of their military to take out lines of credit to feed and shelter their families…i think not///we are now part a “military” of sorts–we need to be physically and financially protected…who on this PCC and/or AAP platform can help with these ideas?

i will try to attach our letter from MD to the senate as of 3/25/20.
thank you for your time,
Kirsten Brinkmann
The Maryland Pediatric Group
Lutherville, MD 21093

MedChi Sign On Letter to Congressional Leadership (3-25-2020).pdf (493.7 KB)


Overall, solid advise. I would just comment on a few items.

  1. I would recommend WELL in the AM and Sick in the afternoon. This way, you are not bringing well children in after you have seen sick. Considering how long COVID remains in the environment, I would think this would be the safest way to do this. (It is what we are doing)
  2. After one week of televisits, we have found that even though parents are home during the day, the biggest demand for the televisits has been after 6pm! Surprising to us as well, and this may just be due to just starting the televisits this week. However, we have done 1/2 of our total televisits beteen 6pm and 8:30 pm! We are now increasing our capacity in the evening for TVs. Although we are doing televisits during this time, we have kept our offices closed, so we have decreased overhead (by a little…but everything helps now).