Covid Community Story Washington Practice

As the pandemic surges around the country, practices in the earliest-hit locations are finally seeing a light at the end of the tunnel. Recently, Glenda Smith—a practice administrator at Proliance Surgeons Bellevue Ear Nose and Throat Clinic and Lake Washington Facial Plastics and Rejuvenation spoke with Healthcare Training Leader. Below, she shares her experiences both during the crisis and as it recedes, and what you can learn from a practice emerging on the other side of the pandemic.

Q: Before we talk about what it’s been like for you and your practice since the beginning of the pandemic, let’s talk about right now. What’s been on your mind lately?

A: Like everyone else when COVID-19 showed up in Washington (for us it was February/March), the information from the Centers for Disease Control and Prevention (CDC) and Department of Health (HHS) was just emerging and was frequently changing. We experienced a chaotic rush to understand what was important for the safety of patients, physicians, and staff, while redesigning the business to survive what was ahead. Now, with much more knowledge, the curve trending downward, and opportunity to reopen to full patient care, my mind is focused on returning to a new normal—knowing that this pandemic changed us in ways that will leave lasting marks.

Q: What marks has the virus left behind?

A: Our patient services have been redefined with a new priority of safety. Just this week we have opened for elective services and hear sheltered patients emerging with different expectations. We reassure them by adhering to distancing, screening, and masking precautions. The loss of dependable livelihood also affected our staff for a period of time, but I like to think they also drew reassurance from a workplace that cares about them through very tough times. This has changed our team dynamics. Our practice is currently in recovery, both financially and emotionally. To get things started, we are revising revise every process in our practice involved in delivery of care.

Q: You said that the week the virus really took off—early in February–was the one of the toughest weeks of your career. Besides the obvious, what made that week so difficult?

A: No one outside of the area really knew what we were going through. I was clicking onto one of my regular [online] discussion boards for COVID-19 help looking for help from others going through this. However, I quickly found, we were one of the first areas being hit. So, we’d have to figure this out on our own. From blog posts and chat room discussions, I could see that medical practices in other geographic locations had no idea what was coming their way, and I felt some responsibility to warn them to get prepared.

Plus, at that time we were hearing so many different things—so much conflicting information on COVID-19—even from official sources. On a personal level, the weight of so much change at one time with few resources made for very long days. I often felt like a deer staring into the headlights of a fast moving vehicle.

Q: How has your business changed as a result of COVID-19?

A: Overall, business during COVID-19 containment fell by about 65-70 percent. This is mainly because we could not provide elective services to our patients after the shutdown. Our doctors quickly adapted to providing telehealth visits and saw only urgent services within the clinic. It was a very tough time.

Now that we are reopening, we are finding that some patients who had to postpone the care they needed are sicker then pre-COVID-19. They needed our immediate attention. At the same time, we have long lists of surgery patients eager to get back on schedule. However, I anticipate our reopening will feel more like a slow turn of the dial rather than flip of the switch. People in our area are still cautious about exposing themselves to the virus. So, the biggest change is reassuring them with well-communicated safety precautions.

Q: Have you had to cut costs at all due to the pandemic?

Yes. We very quickly contacted our vendors. The vast majority were willing to work with us and change our payment terms from net 30 to net 60 or even 90. We also reduced our staff hours. Most of our staff went to partial or full standby with a total reduction of 65 percent. Our management team took a temporary cut in pay, and our physicians took no salaries at all. Everybody was doing what they could.

Q: How are your staff members handling changes in their employment situations?

A:. In the beginning, it was a wild scramble for our staff. Many went to file for unemployment to help bridge the financial gap of losing wages. But, even though our State expanded unemployment opportunities, the eligibility requirements were frequently changing, which made it hard for employee to know what to do.

Between the partial hours we have been able to give our staff, and the stimulus money from various programs, they’re doing ok. We are continuing to pay benefits. We also worked out a strategy with our local hospitals so that our staff could work in those locations and fill in for sick hospital staff. This helped staff have hope that we’d made it through the chaos.

All of our employees have accumulations of PTO (paid time off), and we offered flexibility in using it knowing it would help their financial planning. A number opted not to use their PTO and instead are saving it should it be needed for the next “rainy day.”

Q: What advice would you give other administrators who are having tough conversations with their staff about reducing hours to furloughing?

A: It’s not going to be easy. We have almost 50 staff members. I’d recommend meeting individually with each and every one of them. You must know what they need so you can make informed decisions, do you can try and help. Your staff need to hear you convey that you’ll do your best to get through this crisis with them. Some staff will want every hour you can give to them. Others may be immunocompromised—or just scared—and not want to work at all. And then you have everything in between. To have that “temperature read” on every single person was very important as I developed our strategy.

Constant communication is also important. Each of our eight surgeons have been writing a weekly letter to all staff. The first included a lot of gratitude and focused on how we were all going to get through and survive. This isn’t the first crisis our practice has been through—we’ve been around for over 60 years. Now, the physician letters are more hope-filled, visionary, and focusing on the future. One surgeon even put together a playlist of ‘homebound songs’ to share with everyone. These communications have played a huge part in our ability to start to get back up and running.

Q: How have your patients reacted to the changes in your practice during the pandemic?

A: At first, we were fumbling all over ourselves figuring out what to say to patients who needed the elective care that we were temporarily restricted from providing. We quickly created reassuring scripts with clear messages that our front desk staff or schedulers could offer patients.

In the first weeks, patients had some resistance, and we had a couple of instances of patients becoming argumentative. But overall, the vast majority of patients appreciated the precautions we were taking. Again, clearly communicating with patients was key. I’ve also found that patient perspectives have changed. Now, the added precautions are part of the delivery of care that our patients want and expect.

Q: Did you hit any glitches while getting your telehealth program up and running so quickly?

It’s been trial and error. We started with one vendor platform and found that it was too difficult for our patients to use and not as intuitive as we’d like. We switched to another platform that has worked much better. The billing process took some footwork, but we eventually got the correct coding protocols in place, and most of our health plans have been proactive to add telehealth visits to their covered services.

It’s taken some time to get the workflows right. Now, the only part that’s a bit awkward is patient registration. Typically, onboarding a patient is a straightforward process. With telehealth, patients don’t always come in through the predictable channels. They sometimes come in through the “back door.” Say, a physician has set them up in the system without going through the usual registration process. Then the front desk gets left out, and this has caused some issues. But we are working that out.

Q: Have you started thinking about how your practice will regain lost revenue resulting from the pandemic?

Yes, absolutely. We’ve been consistently reaching out to patients since the beginning to keep them engaged. We did a very early email blast regarding the virus of precautions patients should be taking. We’ve done email communication about new treatments in sleep medicine and taking care of your voice. Our goal is to have our patients know we are thinking about them, even though things are upside down.

With the reduction in patients, our doctors have had some additional time to personally stay in contact with patients as well. They’ve also been thinking about we can help our community better cope with the outbreak. For example, our pediatric otolaryngologist has offered complimentary telehealth visits to first responders and ICU, ER and respiratory staff in our community. We’ve also been reaching out to our referral sources—particularly the PCPs—to let them know we’re still available and to offer help.

Q: Are there any protocols you’ve put in place during the pandemic that you’ll keep going forward?

A: Yes, we’re going to continue the enhanced cleaning precautions. Particularly at our front desk, wiping down little things like pens, the desk, credit cards—we’ll keep doing that. We will continue screening patients for symptoms, requiring masks and distancing. The magazines have all been tossed and most likely won’t return, and we’ll need to replace the children’s toys and books with new ways to entertain the kids that come to the office. We have permanently changed back office mask precautions for procedures and instrument cleaning. And the communal snack jars in the lunchroom will continue to only have individually-wrapped goodies.

Many practices like Glenda’s have reached out to us to share their COVID-19 stories of challenge, survival and positive spirit. If you’d like to submit your COVID-19 story, you can do so at: your COVID-19 community story.