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.