Background of Impact of COVID-19 Pandemic to Pediatric Practice Total Visits:
This was the 2nd full week of the national impact of the Coronavirus pandemic. During this second week the number of patients confirmed positive for COVID-19 in the United States climbed to the highest positive COVID-19 cases of any country in the world. Most Pediatric practices were seeing well, sick visit in the office as well as sick visits via telemedicine during the last two weeks. As of the end of the 2nd week of the National Pandemic, the average Pediatric practice who is a client of PhysicianXpress had a 55% decrease in total visits (office and telehealth) as compared to the average weekly visit volume for the two weeks prior to the COVID-19 pandemic (early March).
Disclaimer: This article is not meant as medical, legal or accounting advice. There are many documents and references for Medical, legal and accounting advice that relates to the CARES Act and Families First Coronavirus Response Act.
What is the potential revenue impact on the total visit decline seen during the COVID-19 Pandemic?
The average Pediatric practice we support maintain about 27 days in Accounts Receivable. Based on the 27 AR days and if this visit trend continues, most practices should plan for a 35-55% decline in revenue in about 3-4 weeks (by early to Mid-April). The amount of revenue decline depends on the practice visit volume loss as well as a % of revenue from monthly capitation payments.
How are Pediatric practices optimizing patient care and visits during this time when patients and families are staying home?
Pediatric practices protect their families and the community by taking an optimal approach to treatment. Most Pediatric practices report a triage approach to treating sick patients and conducting well visits during COVID-19. The pediatric practices help families optimize their treatment approach and potentially help them reduce exposure. If the Pediatric practice was not operating during this pandemic, many families would just walk into the ER, an Urgent care center or a retail clinic and potentially increase exposure risk of their children to COVID or risk vaccine protection against other diseases. It is very important to our country that the local Pediatric practice in the community continues to operate and provide care for the community.
While this is not medical advice, most Pediatric practices are:
- bringing in well visit when possible (focus under 5 years of age – note there is risk to patients who are not protected by certain vaccines including MMR and Prevnar),
- triage sick patients to either live visits in the office or manage via telehealth.
Another innovative approach reported is managing well visits in the office and managing some of the sick visits as drive up care (using protective equipment). Interesting that there was an article in the Wall Street Journal written by physician (urologist) in the Boston area on 3/27/20 that predicts this type of innovative approach for sick care might be more desired by parents of sick children in the future.
How can the Families First Coronavirus Response act impact our practice?
Each practice leader should research and understand this act as well as evaluate the potential impact for planning purposes. On March 18th, the Families First Coronavirus Response Act was signed into law to provide both new Sick (Emergency Paid Sick Leave) and FMLA rules starting 4/1/20.
While this act applies to all businesses with less than 500 employees, the act states that an employer who is a healthcare provider may elect to exclude those employees. (note that the Medical Group Management Association (MGMA) lists this as an exclusion in their summary as well). Although MGMA has a very strong policy team, recommend that practice leaders review this act and determine if they prefer to consult their attorney or other trusted resource.
For the Emergency Paid Sick Leave:
Covered employers must make up to 80 hours of paid sick leave available for certain Coronavirus-related absences, in addition to any current paid time off provided by the employer
Note there are many details including when an employee is covered (for instance: a parent needing to stay home and take care of a child that is unable to go to school).
For the paid FMLA Leave:
The first 10 days of leave is not paid and the employee is allowed to substitute any accrued vacation, personal or medical/sick leave for unpaid leave.
After the first ten days, the employer must provide the employee no less than two-thirds of the employee’s usual pay, capped at $200/day ($10,000 aggregate).
Note there are many details including what is covered (for instance a parent needing to stay home and take care of a child that is unable to go to school).
Recommend that practice leaders research and understand the Families First CoronaVirus Response Act in detail and develop some questions to discuss with the accountant of the practice.
How can the Coronavirus Aid, Relief, and Economic Security (“CARES”) Act Benefit our Pediatric Practice?
Each practice leader should research and understand this act as well as evaluate the potential impact for planning purposes. On March 27th, the CARES Act was signed into law to provide a stimulus package to the economy.
As part of the CARES act, there is a Paycheck Protection program that for businesses less than 500 employees can leverage to take a loan to cover payroll for two months and have the loan forgiven (note certain restrictions). The purpose of this loan/grant is to provide Forgiveness for loans provided to small businesses that retain employees. The bill creates a “paycheck protection program” that would provide 8 weeks of cash-flow assistance through federally guaranteed loans to small employers, including medical groups, who maintain their payroll during this emergency. If the medical group maintains payroll, the portion of the loans used for covered payroll costs, interest on mortgage obligations, rent, and utilities would be forgiven, helping workers remain employed. The loan period is retroactive to Feb. 15, 2020 and extends through June 30, 2020.
Recommend that practice leaders consult sba.gov for details related to applying as well as consult with their accountant.
What actions should we consider as practice leaders after two weeks of the national Pandemic?
Every pediatric practice leader learned much over the last two weeks related to patient care during the COVID-19 pandemic. After first revisiting and confirming the treatment approach, a practice leader should consider evaluating the potential impact (e.g. 50% decline in visit volume and revenue), how long they anticipate this reduced visit volume, modify and/or update their patient engagement approach and then plan the optimal resources needed for the time frame with reduced total visits (e.g. next 3-8 weeks).
While the appropriate actions and decisions vary based on each Pediatric practice structure, size and choices that the leaders will make, there are some common actions each practice should consider. Below are a few considerations/suggestions for each Pediatric Practice Leader:
- Evaluate & update office hours and telemedicine approach. During this Pandemic time when families are staying home, families are seeking options to be seen in the office as well as telehealth. The families are home (in general) so the office hours can reduce to 9-5 or even less in some cases and Tele Medicine until 9 pm or later.
Evaluate and determine the impact of pandemic on practice staffing needs. The pandemic has dramatically reduced total visits (office and telemedicine) to Pediatric practices. Some details to evaluate:
- Forecast the amount of workload for Pediatric providers. For instance, if the total visit volume is down by 50-55% (average seen by many Pediatric practices we work with during last two weeks), a ‘rough forecast’ would be the practice needs 50% less Pediatric providers during the time of the pandemic impact.
- Determine the approach for Pediatric providers staffing during the pandemic impact stages (e.g. 3-8 weeks). If the practice needs 50% less Pediatric Providers, consider moving all Pediatric providers to 3/4th time or ½ time. For example, if the office has two providers, maybe only have one Pediatric provider a day at the office.
- Determine the approach for support staff at the Pediatric practice. If there is 50-55% less provider hours, the staff hours can be reduced in many cases by 30-45% (note that there is some work that staff can help or catch up on).
- Forecast potential visits and revenue anticipated over the next 4-8 weeks. If a practice experiences ‘average’ decline, the practice leaders should plan on a 50% decline on visits during the next 3-8 weeks. If consider a 50% decline in visits, a ‘rough’ estimate on total impact would be at least a 50% reduction in the average Fee-For-Service revenue seen at the practice while still maintaining all capitation revenue.
- Understand the potential impact of the Families First Coronavirus Act. Read the March 18th Families First Coronavirus Response Act and attend a webinar on this topic and/or consult with your accountant on the impact to your practice.
- Determine if the Paycheck Protection program of the CARES act is appropriate for your practice. Recommend that all Pediatric practice leaders have a discussion this week with the accountant for the practice related to some of the choices discussed as well as invest time to research and understand the impact of the CARES Act and Families First Coronavirus Response Act
- Determine the Staffing Approach for your Pediatric Practice over the next two months. Analyze and determine if the practice will reduce hours, lay off some staff or keep full payroll and potentially leverage the Paycheck Protection Program that is part of the CARE’s Act.
As a leader, this is a time to review the appropriate level of information, consultant with other partners in the practice as well as the practice accountant prior to making many of these decisions. Some decisions are more time sensitive than others and keep in mind that the information available to make some of these decisions will not be perfect due to the speed of the pandemic impact.
A trusted Pediatric practice is a critical resource in each local community. Thanks for your efforts for leading your practice so the Pediatric group can provide optimal Pediatric care in your community.
Please share comments/feedback and suggestions based on learnings in your Pediatric practice.