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Outperforming market through

innovation Innovativetechnologysolutions

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Evidence-based thought

leadership

Vast network of knowledge

sharing

Expertise & support in areas

of need

Data & Analytics Advisory ServicesPhysician

Collaborative

Challenging the way we think about and address medical group performance


Physician Enterprise Presenters & Contact Information

Please reach out to our Physician Enterprise leadership to assist with any questions related to this information or to discuss any potential areas of need.

Philip Meador, MSHADirector, Physician Enterprise Collaborative [email protected]

Kris Hammarstrom, MHSASenior Performance Partner, Physician Enterprise Advisory [email protected]

Patrick Rickert, MSHA, MBASenior Performance Partner, Physician Enterprise Advisory [email protected]

Michael Roan, CMPESenior Performance Partner, Physician Enterprise Advisory [email protected]

Kearin Schulte, MS, CMPEVice President, Physician Enterprise Advisory [email protected]

Aaron Browne, PA-CManager, Physician Enterprise Advisory [email protected]

Emily Levin, MHASenior Performance Partner, Physician Enterprise Advisory [email protected]

mailto:[email protected]








Webinar Objectives

Provide an actionable framework and review the relevant operational, financial, and clinical considerations for navigating the post COVID-19

impacts within your ambulatory operations.

Given the unprecedented level of appointment cancelations currently averaging 40-50%, and practice wRVUs dropping a dramatic 60-70%, the operational and financial pressures and planned responses are more imperative than ever. Our discussion will focus on strategies that will result in revenue enhancement while returning operations to a “new normal,” and what we are hearing about how other organizations across the country are addressing these same challenges.

Today’s topics will include:• Patient Access & Scheduling• Team Wellness• Practice Operations, Staffing, & Space Utilization• Stimulus Resources


Additional Resources

• COVID-19 screening procedures• PPE conservation policies• Patient transport procedures• Staff training manuals

• Sourcing plans for DIY masks• Staff allocation• Decontamination protocols

Premier has also created a site of best practices library including:


Placeholder for introductory question

Which stage of the COVID-19 response is your organization currently experiencing?

a) Waiting for COVID surge

b) High volume of COVID cases

c) Peak of anticipated COVID volume

d) De-escalation of cases

e) Initiated post-COVID operations


Patient Access & Scheduling


Decline in Ambulatory Volumes

Note: Based on Premier’s InflowHealth Medical Practice Manager 19,288 cFTEs across 23 states from 7/2019 to 4/2020

• Across the country, ambulatory practices experienced a sharp decline in volumes beginning the week of March 15th.

• Over a two-week period, there was a 68% decrease in ambulatory encounters.

• Beginning in mid-April, ambulatory practices began to see slight increases in volumes.

Where did the patients go, and when will they come back?

0

100,000

200,000

300,000

400,000

500,000

600,000

7/7/

19

7/21

/19

8/4/

19

8/18

/19

9/1/

19

9/15

/19

9/29

/19

10/1

3/19

10/2

7/19

11/1

0/19

11/2

4/19

12/8

/19

12/2

2/19

1/5/

20

1/19

/20

2/2/

20

2/16

/20

3/1/

20

3/15

/20

3/29

/20

4/12

/20

4/26

/20

Enco

unte

r Cou

nt

Week Of:

Ambulatory E&M Encounters

COVID-19

Holidays


Preparing for the Ambulatory Surge

• The ambulatory volume drop off has continued into April, with indications that volumes will increase in May.

• Practices will need to anticipate and prepare for a large backlog of patients waiting to be seen.

• This will result in ambulatory volumes exceeding those in a pre-COVID-19 baseline period.

Patient Demand

Note: Based on Premier’s InflowHealth Medical Practice Manager 19,288 cFTEs across 23 states from 7/2019 to 4/2020


Extended Operating Hours Will Not Close the Gap

6:00 PM

2:30 PM

10:30 AM

7:00 AM

9:00 AM

12:00 PM

4:00 PM

5:00 PM

12:00 PM

8:00 AM

M Tu W Th F M Tu W Th FSu Sa

Clinic-based Illustration

Traditional ScheduleHours: 8:00 AM to 5:00 PM, Monday through FridayVisit Slots: 15 min. establish, 30 min. new140 WEEKLY SLOTS

Expanded ScheduleHours: 7:00 AM to 6:00 PM, Monday through Friday,

Saturday and Sunday availabilityVisit Slots: 30 min. establish, 45 min. new

110 WEEKLY SLOTS


Maximizing Modalities

The physician needs to quarterback the care and leverage other providers to manage through current demand.


Patient Perspective & Call to Action

Deliver clear appointment expectations and visitor guidelines

Solicit feedback and actively

communicate schedule changes

to patients

Provide channels of support for

patients to address financial

concerns

• Create patient scheduling lists• Engage providers and clinical staff in

rescheduling practices and template changes

• Develop clear decision matrix for rescheduling patients based on capacity

• Develop clear communication pathways for patients

• Inventory and analyze provider capacity pre and post-COVID

• Review automated communications and FAQs

Focus on the PatientCall to Action


Placeholder for polling question

Please describe where you are in your approach for provider scheduling ramp up?

1. Analysis and planning2. Prioritization of services3. Proactively scheduling4. At or beyond capacity5. Reached the new normal


Team Wellness


Focusing on Wellness Enables Mental Health

Emphasize Staff Wellness

Address Mental Health Concerns

Monitor Effort

Assess Workflows& Space

Focus on Returning Teams

Evaluate Care Team Structure

Create a Culture of Wellness

Optimize EHR


Redefining Wellness

Now more than ever, it is important for health care organizations to foster an environment that supports providers, nurses and care team members

Safe

Prepared

Healthy

Supported

• Adequate PPE• Safe clinical space for staff• Workflow redesign to reduce

contact with patients and staff

• Update guidelines, protocols and expectations

• Offer re-training to returning teams

• Analyze workload redistribution

• Culture of wellness focused on team health

• Emphasize EAP offerings• Offer additional support

services

• Open communication and feedback loop

• Monitor work hours• Ensure time for breaks• Look to reduce administrative

burden


Call to Action

• Remember that providers are patients too

• Foster a team-based culture of wellness that emphasizes communication and real-time feedback between team members

• Continually monitor effort of your teams and providers

• Develop a plan to improve practice inefficiencies in order to support providers and clinicians

• Evaluate solutions to address the basic social needs and mental health concerns of all your team members

• Actively seek and identify potential alternative wellness programs to support your care teams

Call to Action



What strategies has your organization implemented to support team wellness and health? (Select all that apply)

1. Supplemental/hazard payments2. Additional time off3. Peer-to-peer support programs4. Employee Assistance Programs5. Mental Health Surveys6. Appointed a Wellness Champion


Practice Operations, Staffing &Space Utilization


Realities of the “New Normal”

In a post-COVID-19 clinical environment, organizations must think about Practice Operations, Staffing, Space, and Technology as co-dependent throughout the

patient’s pre-, during, and post-visit experience. Utilize this opportunity to creatively redesign the delivery of healthcare in a way that always puts in the patient in the center of care.

Technology

SpaceUtilization

Reconfiguration of patient flow to minimize physical interactions.Share safety measures and precautions with patients.Regular sanitation of patient-facing areas and shared workspaces.

Pre-visit

During

Post-visit

Space

Patient-centered Care Delivery Models

Practice Operations

Social distancing practices (e.g., patients wait in their cars instead of in the waiting room).Visitor guidelines with the option of virtual support.Virtual visit and remote monitoring coding education.

Pre-visit

During

Post-visit

Practice Operations

TechnologyReduction of touchpoints during check-in through use of patient portal.Confirm bi-directional privacy during a virtual visit.Remote monitoring capabilities and virtual visits for established patients. Educate patients on expectations on both workflows.

Pre-visit

During

Post-visit

“Benched” staff to support other workflows, such as answering phone trees to reduce wait times.Focus on working top of license (e.g., reintroducing nurse-only visits can help with bolus of patients).Staffing models to sustain remote monitoring, reducing the number of times a patient must “go to” a provider.

Pre-visit

During

Post-visit

Staffing

Staffing


Understanding Rate Limiting Factors

The rate limiting factors for all services are people, space, equipment, supplies and time. Understanding your specific needs before they arise and pulling levers to add capacity where possible will enable a smoother, more profitable transition.

PRN staff

Reallocating or utilizing temporary space

Utilize services that do not require additional space

Extending hours

Purchasing sufficient supplies


Anticipate a New Way of Operations

Leaders should consider how prepared their practices are to address or maintain themes stemming from the response to COVID-19: Regardless of the extent of

operational change, remember the following:

Listen to your teams. Solicit feedback on your response to COVID-19.

Demonstrate and communicate how your practice is a safe place for patients to

visit and for staff to work.

Re-evaluate. Re-educate. Communicate.

Implement regular education on proper use of PPE.

Minimize touchpoints and unnecessary physical interactions.

Maintain high levels of infection prevention and control.

Stay Safe and Diligent.

Encourage the discovery of a “new way” to deliver healthcare.

Design the Future.

Technology

Virtual technologies for clinical and non-clinical staff.

Emerging EHR technologies to enhance workflows.

Proactively manage specific patient populations by disease type, sick vs. healthy, or age.

Rethink the waiting room, in general.

Socially-distant pre-visit experience with PPE.

Reduce touchpoints by capturing front-end documents via patient portal.

Patient Experienceand Safety

Train staff on both in-person and virtual workflows.

Extend operations to offer family-friendly hours.

Encourage providers to complete make-up clinics.Shift in visit types and rendering providers for certain appointments.Practice Operations

Rapid growth of virtual health.


New Age of Waiting Rooms

In addition to virtual waiting rooms, practices across the country are changing the physical layout of their waiting rooms.


Example Decision Matrix

• Patient call to office / PCH• Video / E-visit• Patient arrives at office

• No symptoms• Known exposure to PUI

or COVID+• Not sent to urgent care

for contact tracing purposes

• No symptoms• Patient sent to Urgent

Care by employer for evaluation & testing due to contact tracing from known exposure

Severe symptomsAny of these:

• Severe trouble breathing• Persistent pain or

pressure in the chest• New confusion• Inability to wake or stay

awake• Blush lips or face

• Cough• SOA• Fever

• Sore throat• Aches• Chills

• Quarantine per COVID-19 Return to Work protocol

• Evaluate & test for COVID-19

• Quarantine per Return to Work protocol

• Refer to Urgent Care• Test for flu/strep if

warranted• COVID-19 test• Quarantine per COVID

Return to Work protocol

• Go to ED• Notify ED• Mask if Possible

Mild/Moderate symptomsAny of these:

• Recent loss smell/taste


Addressing Staffing Needs


Resetting Your Space

COVID-19 Generated

FacilitiesRamping Up

Opportunity to Right size

Space and Safety

Effective and continual modeling to manage the pace and timeline of ramping up clinical services.

Properly inventory historical, current, and future allocation and availability of space.

Organizations should challenge historic notions of safety in clinic spaces, including the infrastructure itself.

For example: • Waiting room designs• Rethink patient flow as “one way”• Installing more protective barriers• Reduce shared working space

Rethink where providers will be physically practicing as the practice of medicine shifts towards telehealth.

Identify potential efficiencies by re-evaluating adjacencies. Utilize this time to re-assess the space utilization and allocation of the clinic network.

Have a plan in place for COVID-19 generated facility closures.

Return to original space utilization or transition to new use of space. Critically challenge the allocation of space in your system. Now may be the perfect opportunity to shift clinics around and reallocate space.


Patient Perspective & Call to Action

• Emphasize infection prevention and control through safety procedures

• Develop communication strategies to assure patients of new standards

• Assess workflow design (pre-, during and post-visit) to address safety concerns for both patients and staff

• Identify possible updates or enhancements to the EHR, or additional technologies, to increase clinical efficiencies

• Proactively plan for addressing staffing variances as a result of COVID-19

• Create a detailed plan for returning furloughed staff to work based on volume increases and performed duties

• Inventory space utilization of historical, current and future space utilization

Call to Action Focus on the Patient

New clinic workflows to

minimize patient contact

points

Clear communication

around visit expectations

Enhanced signage

emphasizing new safety procedures



What element of your practice operations are you most concerned about?

1. PPE / supplies2. Staffing levels and skill-mix 3. Provider capacity & burnout4. Environment of safety5. Other


Stimulus Resources


Gra

nt F

undi

ng

COVID-19 Telehealth Program (1) $1 Million per applicant

(1) Nonprofit and public healthcare providers(2) Commission interested in areas most disrupted by

COVID-19

CARES Provider Relief Fund

(1) $50 Billion (general distribution)(2) $12 Billion to COVID High Impact areas(3) $10 Billion to rural providers(4) $500 Million to IHS facilities(5) $4.9 Billion to SNFs(6) Portion of remaining funding to

reimburse uninsured

(1) Valid Tax ID(2) Received Medicare FFS in 2019 ($30B of Gen. Distr.)(3) Submit 2018 NPR to CMS ($20B of Gen. Distr.)(4) Submit ICU Bed, COVID-19 admission via portal (High

Impact Area funding)(5) Located in a Rural geography (Rural Provider funding)(6) Enroll and submit claims to receive uninsured funding

Telehealth Network Grant Program (1) $300K per subject year

(1) Geographic requirements(2) Telehealth composition(3) Nonprofit status for those providing services(4) Program capped at 29 participants

COVID-19 Stimulus Funding Summary

Information last updated on May 22, 2020

Stimulus Program Maximum Available Amount Program Limitations

Loan

s Pr

ogra

ms SBA Paycheck Protection

Program (PPP)(1) $10 Million - OR -(2) Avg Monthly Payroll X 2.5

(1) Maximum 500 employees(2) Limitations on intended fund Uses

Main Street New Loan Facility

(1) $25 Million – OR –(2) 4X 2019 EBITDA when added to

outstanding, but undrawn, debt

(1) Maximum 15,000 employees(2) Maximum 2019 Revenues $5 Billion(3) Minimum loan of $500K(4) Have not received support outside of PPP under

CARES Act(5) Usage restrictions under CARES Act

Stimulus Program Maximum Available Amount Program Limitations

• Effective April 26, 2020 CMS is no longer accepting new applications for the Medicare Accelerated and Advance Payment Program

• Effective May 4, 2020 the U.S. Small Business Administration reopened the Economic Injury Disaster Loan program only for agricultural businesses, thus closing the opportunity for healthcare providers


Call to Action

• Project patient volume, available revenue streams, and expense expectations in order to assess impacts relative to budgets and fiscal year goals

• Determine the organization’s ability to repay any applied-for stimulus loans based on volume and financial projections

• Verify intended use of funds will follow guidelines outlined in each stimulus offering – ensure legal, HR, and financial leadership are coordinated

• Apply to stimulus offerings as soon as possible

• Attest to funding receipt shortly after receiving funds to remain in compliant with terms & conditions of funding

Call to Action



To what degree are you utilizing or taking advantage of stimulus resources?

1. Not interested2. Currently Evaluating3. Applied for & decision pending4. Approved & awaiting funds5. Funding received & retained6. Received funds & returned


Q&A


Thank You and Next Steps

What can you expect next?• Part II of the webinar will be held on June 4th, 11:00 – 12:00 p.m. Topics include:

• Part I Recap

• Additional Operations Topics

• Clinical Services & Ancillary Coordination

• Virtual Technologies

• Financial Management & Stimulus Resources

• Polling questions and results from today’s session will be reviewed.

• Any questions not answered today will be addressed in next week’s webinar.

• We are here to help address your needs and support you.

© 2020. all rights reserved. | premier inc. |...

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