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Survey Says: Practice Vigilance is Paying Off
In May 2020, BSM Consulting surveyed ophthalmology clients regarding their reopening efforts amid COVID-19. In September 2020, the same clients were surveyed a second time to measure their progress, struggles, and plans for success. More than 100 multispecialty and subspecialty practices from around the country responded. Below, we compare these data points in an effort to provide valuable insight on the progress, challenges, and momentum gained since COVID first appeared in the U.S. It’s our hope that this knowledge can be used to help practices move forward, continuing the upward trajectory detailed in the results below.
Progression Toward Pre-COVID Practice Activity
When initially surveyed about practice activity, only 12.4 percent of respondents said they were experiencing patient activity levels at or above 76 percent of pre-COVID levels. As of September, this number had increased to more than 70 percent of reported practices. In addition to state and federal mandates lifting restrictions for non-essential services, this increase may be a result of the hard work practices completed to prepare themselves for a safe re-opening.
It is encouraging to see that activity levels and patient volume have increased since the initial survey was conducted in May. Clearly, progress is being made in different parts of the country due to creativity, hard work, and a focus on taking care of patients and employees. Some of the creative measures we have seen include offering onsite “schools” for young kids, where they can complete their online coursework while mom or dad works in the clinic; offering extended hours to accommodate spaced-out patient scheduling; and utilizing technology to provide patients with “touchless” services whenever possible.
Taking Care of Our People
Staffing levels in practices are also returning to normal, with more than 90 percent of practices reporting that as of Sept. 1, their staffing levels are at least 76 percent of pre-COVID numbers. Encouragingly, more than 62 percent of practices say they anticipate hiring more staff in the next three months.
The pandemic helped many practices realize that current technology allows for nonclinical functions — e.g., billing, administration, and patient scheduling — to be performed at home with regular communication via phone and video calls. As a result, nearly half of practice respondents reported they have some staff members working remotely where their roles allow this. A significant number of practices reported success in these efforts, with some considering continuing remote opportunities for certain staff given the potential for maintaining productivity and lowering costs.
Perhaps as a result of these remote working conditions, exposure rates of staff have been kept at low levels. Of the respondents, 20 percent reported no staff being absent or quarantined due to symptoms, positive tests, or exposure. Meanwhile, another 60 percent of respondents reported having less than 10 percent of staff impacted. In addition to shifting some employees to remote positions, it’s likely that these low exposure rates have also been achieved through the implementation of good policies and the diligent use of personal protective equipment (PPE). While it cannot be denied that other clinics have experienced more difficulty, it’s nice to see that 80 percent of all respondents have not had serious implications — due, in part, to their diligence in keeping both staff and patients safe.
Despite this measurable progress, we still hear of childcare challenges, health risks, and employee burnout that leave many groups struggling to find enough staff. These practices are learning to approach staffing strategically by being creative with schedules and work modifications, scheduling staff based on projected patient volumes and considering new patient flow requirements necessary to keep everyone safe. For example, extended hours allow clinics to implement staggered shifts where staff start earlier or later in the day. Additionally, being more diligent in communicating with patients before or after their visit, along with utilizing technology to reduce the amount of staff needed for check-in and check-out, have also proven effective.
Keeping Our Staff and Patients Safe
In addition to letting some office staff work remotely, about two-thirds of practices reported using telemedicine in some capacity. The most common services offered include patient follow-ups, same-day emergencies, and triage. Just over 10 percent of respondents reported providing medical exams for select conditions, as well. We at BSM know some practices have since discontinued these services post-shut down either because of challenging reimbursement policies or their preference for face-to-face medical care. Still, it serves to illustrate the ingenuity and creative nature many practices tapped into while navigating the pandemic.
When asked what has contributed most to the success in reopening, the clear leader was PPE and safety precautions. While most practices have become extremely good with the safeguards they offer, it has not been easy. The September survey revealed that PPE was rated as the most challenging effort in the road to recovery (followed by staffing, patient scheduling, and clinic flow, in that order). Initially, there were limited supplies of some PPE. To add to this, getting both staff and patients comfortable and committed to wearing PPE consistently and appropriately took patience and diligence. The good news is that many offices now report a greater acceptance rate for PPE use, as well as easier access to the supplies themselves.
Ongoing Precautionary Measures
To keep the flow of patients coming into clinics, practices must continue to implement the important steps they have learned to keep people safe. The top four precautions identified to accomplish this are in Figure 2 (below).
Through our interactions with clients, BSM knows that many practices are still working hard to recover. As we approach the winter months, continued vigilance will be needed with respect to staff and patient safety. These measures will be important for communities to keep businesses open and for patients to feel safe in returning to their doctor’s office.