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Navigating a pandemic: The importance of preparedness in independent GI practices
It was early March, and our second day of advocacy on Capitol Hill with the Digestive Health Physicians Association (DHPA) was cut short when congressional offices were shuttered because of the COVID-19 pandemic. Sitting with several of my GI physician colleagues from across the country, we knew that our practices, our patients, and our communities would be impacted by the coronavirus. None of us could have known the extent.
We also didn’t know in that moment that our advocacy work through DHPA would be one of the most important factors in ensuring that our practices were prepared to weather the pandemic. Our membership, legal counsel, and legislative lobbyists helped us remain informed about new legislation and regulations and ensured that we had much-needed access to government resources.
Just a few months into what is now the COVID-19 pandemic, independent GI practice leaders have learned a lot about how to strengthen our practices to respond to future crises – and what early-career GIs should look for in the practices they are considering.
First and foremost, practice leadership is key. One thing most successful GI practices have in common is that they hire really smart executives and administrative teams who excel at taking care of the business side of things so that physicians like me can do what we do best: treat patients.
Stay informed about state and federal policies
As a member of DHPA, Capital Digestive Care was well positioned to keep up to date on the government response to the coronavirus and the support it provided to small businesses and to health care providers.
Over the past 5 years, DHPA physician leaders have established strong relationships with our elected federal leaders. During our Capitol Hill visits in early March, we discussed the coronavirus in addition to our policy priorities.
The relationships we’ve built with policymakers have helped us educate them about how private practices were being affected and make the case that it was crucial to include private practices in health care stimulus packages.
Without this federal financial support, many medical groups may have had to close their doors – leaving a large gap in care once the pandemic subsides.
In addition to the federal government’s financial support, our policy advocacy efforts kept us informed about federal health agencies’ decisions on telehealth coverage. We were able to educate our physicians and staff about state and federal adjustments to telehealth rules for the pandemic, on the guidelines for elective procedures, on employee furlough and leave rules, as well as other congressional and state actions that would impact our practice.
You can’t be an independent physician without being open to learning about the business of health care and understanding how health policies affect your ability to practice medicine and care for people in your community. Every early-career physician who is looking to join a practice should ask how its leadership remains informed about health policy at the state and federal levels.
Make plans, be flexible
Implementing telehealth was critical in responding to the coronavirus pandemic. We were able to get up and running quickly on telemedicine because we had already invested in telehealth and had conducted a pilot of the platform with a smaller group of providers well before the pandemic hit.
In March, we were able to expand the telehealth platform to accommodate virtual visits by all of our providers. We also had to figure out how to shift our employees to telework, develop remote desktop and VPN solutions, and make sure that our scheduling and revenue cycle team members were fully operational.
The overriding goal was the safety of patients, staff, and our providers while continuing to provide medical care. Our inflammatory bowel disease patients needing visits to receive medication infusions took over an entire office so that there could be appropriate spacing and limited contacts with staff and other patients.
Our administrators knew early on that we needed a back-up plan and worked with physicians and providers doing telehealth visits to provide the flexibility to switch to Centers for Medicare & Medicaid–approved platforms (including Facetime) for those instances in which patients were uncomfortable using our main platform or when it was strained by bandwidth issues – a common challenge with any platform. Virtual check-in and check-out procedures were developed utilizing our usual office staff from remote locations.
For patients who had indications for gastroenterology procedures, we established a prioritization system, based on state guidelines, for those that were needed urgently or routinely as our endoscopy centers began to reopen. Safety measures were put into place including screening questionnaires, preprocedure COVID rt-PCT testing, personal protective equipment, and workflow changes to achieve social distancing.
As an early-career GI physician who is considering private practice, you’ll likely have several conversations with administrative leaders when deciding what practice to join. Ask about how the practice responded to COVID-19, and what processes it has in place to prepare for future emergencies.
During the early weeks of the pandemic, the CDC Board of Managers met two to three times per week. Task forces to discuss office operations and planning for ambulatory surgery center opening were established with participation by nearly every provider and manager. Communication between all providers and managers was important to decrease the obvious anxiety everyone was experiencing.
Old financial models may no longer work
Most practices develop budgets based on historical data. We quickly figured out that budgets from historical forecasts no longer worked and that we needed to understand the impact to budgets almost in real time.
We immediately looked to conserve cash and reduce expenses, requesting that our large vendors extend payment terms or provide a period of forbearance. We looked at everything from our EMR costs to lab supplies and everything in between.
Changing how we modeled our budgets and reducing costs made some of our hard decisions less difficult. While we had to furlough staff, our models for reducing physician compensation and lowering our costs allowed us to create a model for the return to work that included the use of paid time off and paid health care for our furloughed employees.
Our operations team also set up systems to gather information that was needed to apply for and report on federal loans and grants. They also set up ways to track revenue per visit and appeals for denied telehealth and other services in an effort to create new models and budgets as COVID-19 progressed. The revenue cycle team focused on unpaid older accounts receivable.
Focused on the future
It’s an understatement to say that COVID-19 has forever changed the practice of medicine. The health care industry will need to transform.
For some time now, GI practices have discussed the consequence of disruptive innovation affecting utilization of endoscopic procedures. We were looking at technology that might eventually replace office personnel. No one was thinking about a pandemic that would cause nearly overnight closure of endoscopy suites and curtail the entire in-office administrative workforce. The coronavirus pandemic is likely to be the catalyst that brings many innovations into the mainstream.
We’ll most likely see a transition to the virtual medical office for those visits that don’t require a patient to see a physician in person. This will make online scheduling and registration, on-demand messaging, and remote patient monitoring and chronic care management necessities.
We may also see more rapid adoption of technologies that allow information from health trackers and wearables to be integrated into EMRs that easily follow the patient from physician to physician. Administrative support and patient assistance from remote locations will become the norm.
Inquiring about how practices plan for emergencies and how their leadership thinks about the future of gastroenterology is a great way to show that you’re thinking holistically about health care delivery and how medicine is practiced now and in the future.
So much has changed in the decades I’ve been practicing medicine and so much is yet to change. As early-career GI physicians who are familiar with new technologies, you are in a great position to lead the practices you join into the future of gastroenterology.
Dr. Weinstein is president and CEO of Capital Digestive Care and the immediate past president of the Digestive Health Physicians Association.
It was early March, and our second day of advocacy on Capitol Hill with the Digestive Health Physicians Association (DHPA) was cut short when congressional offices were shuttered because of the COVID-19 pandemic. Sitting with several of my GI physician colleagues from across the country, we knew that our practices, our patients, and our communities would be impacted by the coronavirus. None of us could have known the extent.
We also didn’t know in that moment that our advocacy work through DHPA would be one of the most important factors in ensuring that our practices were prepared to weather the pandemic. Our membership, legal counsel, and legislative lobbyists helped us remain informed about new legislation and regulations and ensured that we had much-needed access to government resources.
Just a few months into what is now the COVID-19 pandemic, independent GI practice leaders have learned a lot about how to strengthen our practices to respond to future crises – and what early-career GIs should look for in the practices they are considering.
First and foremost, practice leadership is key. One thing most successful GI practices have in common is that they hire really smart executives and administrative teams who excel at taking care of the business side of things so that physicians like me can do what we do best: treat patients.
Stay informed about state and federal policies
As a member of DHPA, Capital Digestive Care was well positioned to keep up to date on the government response to the coronavirus and the support it provided to small businesses and to health care providers.
Over the past 5 years, DHPA physician leaders have established strong relationships with our elected federal leaders. During our Capitol Hill visits in early March, we discussed the coronavirus in addition to our policy priorities.
The relationships we’ve built with policymakers have helped us educate them about how private practices were being affected and make the case that it was crucial to include private practices in health care stimulus packages.
Without this federal financial support, many medical groups may have had to close their doors – leaving a large gap in care once the pandemic subsides.
In addition to the federal government’s financial support, our policy advocacy efforts kept us informed about federal health agencies’ decisions on telehealth coverage. We were able to educate our physicians and staff about state and federal adjustments to telehealth rules for the pandemic, on the guidelines for elective procedures, on employee furlough and leave rules, as well as other congressional and state actions that would impact our practice.
You can’t be an independent physician without being open to learning about the business of health care and understanding how health policies affect your ability to practice medicine and care for people in your community. Every early-career physician who is looking to join a practice should ask how its leadership remains informed about health policy at the state and federal levels.
Make plans, be flexible
Implementing telehealth was critical in responding to the coronavirus pandemic. We were able to get up and running quickly on telemedicine because we had already invested in telehealth and had conducted a pilot of the platform with a smaller group of providers well before the pandemic hit.
In March, we were able to expand the telehealth platform to accommodate virtual visits by all of our providers. We also had to figure out how to shift our employees to telework, develop remote desktop and VPN solutions, and make sure that our scheduling and revenue cycle team members were fully operational.
The overriding goal was the safety of patients, staff, and our providers while continuing to provide medical care. Our inflammatory bowel disease patients needing visits to receive medication infusions took over an entire office so that there could be appropriate spacing and limited contacts with staff and other patients.
Our administrators knew early on that we needed a back-up plan and worked with physicians and providers doing telehealth visits to provide the flexibility to switch to Centers for Medicare & Medicaid–approved platforms (including Facetime) for those instances in which patients were uncomfortable using our main platform or when it was strained by bandwidth issues – a common challenge with any platform. Virtual check-in and check-out procedures were developed utilizing our usual office staff from remote locations.
For patients who had indications for gastroenterology procedures, we established a prioritization system, based on state guidelines, for those that were needed urgently or routinely as our endoscopy centers began to reopen. Safety measures were put into place including screening questionnaires, preprocedure COVID rt-PCT testing, personal protective equipment, and workflow changes to achieve social distancing.
As an early-career GI physician who is considering private practice, you’ll likely have several conversations with administrative leaders when deciding what practice to join. Ask about how the practice responded to COVID-19, and what processes it has in place to prepare for future emergencies.
During the early weeks of the pandemic, the CDC Board of Managers met two to three times per week. Task forces to discuss office operations and planning for ambulatory surgery center opening were established with participation by nearly every provider and manager. Communication between all providers and managers was important to decrease the obvious anxiety everyone was experiencing.
Old financial models may no longer work
Most practices develop budgets based on historical data. We quickly figured out that budgets from historical forecasts no longer worked and that we needed to understand the impact to budgets almost in real time.
We immediately looked to conserve cash and reduce expenses, requesting that our large vendors extend payment terms or provide a period of forbearance. We looked at everything from our EMR costs to lab supplies and everything in between.
Changing how we modeled our budgets and reducing costs made some of our hard decisions less difficult. While we had to furlough staff, our models for reducing physician compensation and lowering our costs allowed us to create a model for the return to work that included the use of paid time off and paid health care for our furloughed employees.
Our operations team also set up systems to gather information that was needed to apply for and report on federal loans and grants. They also set up ways to track revenue per visit and appeals for denied telehealth and other services in an effort to create new models and budgets as COVID-19 progressed. The revenue cycle team focused on unpaid older accounts receivable.
Focused on the future
It’s an understatement to say that COVID-19 has forever changed the practice of medicine. The health care industry will need to transform.
For some time now, GI practices have discussed the consequence of disruptive innovation affecting utilization of endoscopic procedures. We were looking at technology that might eventually replace office personnel. No one was thinking about a pandemic that would cause nearly overnight closure of endoscopy suites and curtail the entire in-office administrative workforce. The coronavirus pandemic is likely to be the catalyst that brings many innovations into the mainstream.
We’ll most likely see a transition to the virtual medical office for those visits that don’t require a patient to see a physician in person. This will make online scheduling and registration, on-demand messaging, and remote patient monitoring and chronic care management necessities.
We may also see more rapid adoption of technologies that allow information from health trackers and wearables to be integrated into EMRs that easily follow the patient from physician to physician. Administrative support and patient assistance from remote locations will become the norm.
Inquiring about how practices plan for emergencies and how their leadership thinks about the future of gastroenterology is a great way to show that you’re thinking holistically about health care delivery and how medicine is practiced now and in the future.
So much has changed in the decades I’ve been practicing medicine and so much is yet to change. As early-career GI physicians who are familiar with new technologies, you are in a great position to lead the practices you join into the future of gastroenterology.
Dr. Weinstein is president and CEO of Capital Digestive Care and the immediate past president of the Digestive Health Physicians Association.
It was early March, and our second day of advocacy on Capitol Hill with the Digestive Health Physicians Association (DHPA) was cut short when congressional offices were shuttered because of the COVID-19 pandemic. Sitting with several of my GI physician colleagues from across the country, we knew that our practices, our patients, and our communities would be impacted by the coronavirus. None of us could have known the extent.
We also didn’t know in that moment that our advocacy work through DHPA would be one of the most important factors in ensuring that our practices were prepared to weather the pandemic. Our membership, legal counsel, and legislative lobbyists helped us remain informed about new legislation and regulations and ensured that we had much-needed access to government resources.
Just a few months into what is now the COVID-19 pandemic, independent GI practice leaders have learned a lot about how to strengthen our practices to respond to future crises – and what early-career GIs should look for in the practices they are considering.
First and foremost, practice leadership is key. One thing most successful GI practices have in common is that they hire really smart executives and administrative teams who excel at taking care of the business side of things so that physicians like me can do what we do best: treat patients.
Stay informed about state and federal policies
As a member of DHPA, Capital Digestive Care was well positioned to keep up to date on the government response to the coronavirus and the support it provided to small businesses and to health care providers.
Over the past 5 years, DHPA physician leaders have established strong relationships with our elected federal leaders. During our Capitol Hill visits in early March, we discussed the coronavirus in addition to our policy priorities.
The relationships we’ve built with policymakers have helped us educate them about how private practices were being affected and make the case that it was crucial to include private practices in health care stimulus packages.
Without this federal financial support, many medical groups may have had to close their doors – leaving a large gap in care once the pandemic subsides.
In addition to the federal government’s financial support, our policy advocacy efforts kept us informed about federal health agencies’ decisions on telehealth coverage. We were able to educate our physicians and staff about state and federal adjustments to telehealth rules for the pandemic, on the guidelines for elective procedures, on employee furlough and leave rules, as well as other congressional and state actions that would impact our practice.
You can’t be an independent physician without being open to learning about the business of health care and understanding how health policies affect your ability to practice medicine and care for people in your community. Every early-career physician who is looking to join a practice should ask how its leadership remains informed about health policy at the state and federal levels.
Make plans, be flexible
Implementing telehealth was critical in responding to the coronavirus pandemic. We were able to get up and running quickly on telemedicine because we had already invested in telehealth and had conducted a pilot of the platform with a smaller group of providers well before the pandemic hit.
In March, we were able to expand the telehealth platform to accommodate virtual visits by all of our providers. We also had to figure out how to shift our employees to telework, develop remote desktop and VPN solutions, and make sure that our scheduling and revenue cycle team members were fully operational.
The overriding goal was the safety of patients, staff, and our providers while continuing to provide medical care. Our inflammatory bowel disease patients needing visits to receive medication infusions took over an entire office so that there could be appropriate spacing and limited contacts with staff and other patients.
Our administrators knew early on that we needed a back-up plan and worked with physicians and providers doing telehealth visits to provide the flexibility to switch to Centers for Medicare & Medicaid–approved platforms (including Facetime) for those instances in which patients were uncomfortable using our main platform or when it was strained by bandwidth issues – a common challenge with any platform. Virtual check-in and check-out procedures were developed utilizing our usual office staff from remote locations.
For patients who had indications for gastroenterology procedures, we established a prioritization system, based on state guidelines, for those that were needed urgently or routinely as our endoscopy centers began to reopen. Safety measures were put into place including screening questionnaires, preprocedure COVID rt-PCT testing, personal protective equipment, and workflow changes to achieve social distancing.
As an early-career GI physician who is considering private practice, you’ll likely have several conversations with administrative leaders when deciding what practice to join. Ask about how the practice responded to COVID-19, and what processes it has in place to prepare for future emergencies.
During the early weeks of the pandemic, the CDC Board of Managers met two to three times per week. Task forces to discuss office operations and planning for ambulatory surgery center opening were established with participation by nearly every provider and manager. Communication between all providers and managers was important to decrease the obvious anxiety everyone was experiencing.
Old financial models may no longer work
Most practices develop budgets based on historical data. We quickly figured out that budgets from historical forecasts no longer worked and that we needed to understand the impact to budgets almost in real time.
We immediately looked to conserve cash and reduce expenses, requesting that our large vendors extend payment terms or provide a period of forbearance. We looked at everything from our EMR costs to lab supplies and everything in between.
Changing how we modeled our budgets and reducing costs made some of our hard decisions less difficult. While we had to furlough staff, our models for reducing physician compensation and lowering our costs allowed us to create a model for the return to work that included the use of paid time off and paid health care for our furloughed employees.
Our operations team also set up systems to gather information that was needed to apply for and report on federal loans and grants. They also set up ways to track revenue per visit and appeals for denied telehealth and other services in an effort to create new models and budgets as COVID-19 progressed. The revenue cycle team focused on unpaid older accounts receivable.
Focused on the future
It’s an understatement to say that COVID-19 has forever changed the practice of medicine. The health care industry will need to transform.
For some time now, GI practices have discussed the consequence of disruptive innovation affecting utilization of endoscopic procedures. We were looking at technology that might eventually replace office personnel. No one was thinking about a pandemic that would cause nearly overnight closure of endoscopy suites and curtail the entire in-office administrative workforce. The coronavirus pandemic is likely to be the catalyst that brings many innovations into the mainstream.
We’ll most likely see a transition to the virtual medical office for those visits that don’t require a patient to see a physician in person. This will make online scheduling and registration, on-demand messaging, and remote patient monitoring and chronic care management necessities.
We may also see more rapid adoption of technologies that allow information from health trackers and wearables to be integrated into EMRs that easily follow the patient from physician to physician. Administrative support and patient assistance from remote locations will become the norm.
Inquiring about how practices plan for emergencies and how their leadership thinks about the future of gastroenterology is a great way to show that you’re thinking holistically about health care delivery and how medicine is practiced now and in the future.
So much has changed in the decades I’ve been practicing medicine and so much is yet to change. As early-career GI physicians who are familiar with new technologies, you are in a great position to lead the practices you join into the future of gastroenterology.
Dr. Weinstein is president and CEO of Capital Digestive Care and the immediate past president of the Digestive Health Physicians Association.