Within weeks of the national COVID-19 shutdowns, I wrote a blog about how I planned to use the time to improve my practice.1 Almost a year has passed since then and I decided to look back at what happened to my practice and to the business as a whole.
From the onset of the pandemic, I revised goals, identified new goals and formulated plans for reopening in “the new normal” (which we all initially believed would only be for a few weeks or months). We worked on enhancing staff skills regarding the practice’s response and subsequent messaging on the patient experience. This began with how to answer phones and how we were communicating our procedures for patient safety. It continued with how to schedule more effectively to meet our safety goals, reassuring not only our patients but our community population as a whole that we had done our research, sought out necessary resources and implemented appropriate policies and practices.
Even though we already had proper disinfection procedures in place, we took the opportunity to conduct a refresher course and enhance the how-tos of proper protocols.
I also looked at practice operations to determine any needed changes in areas such as how we engaged with patients and how that translated to their satisfaction and perception of the practice. Other key areas I addressed were billing, the collection process and the financial status of the practice.
At first, the staff was eager to work on their skills but having training every week became boring. instead, they wanted patient interaction. I scaled back on the major training to every two or three weeks but this also became tedious. They liked taking care of patients rather than reading manuals or practicing with each other on things they felt they knew.
I decided to make up skills assessment tests to assess how their perception matched with reality. Unfortunately, my staff soon learned that what they thought they knew did not translate to being able to successfully answer questions about what they should know. Now we are now back to scheduling twice weekly, 15-minute training sessions to perfect skills necessary for an exceptional patient care and service experience.
I also incorporated their desire for patient interaction by utilizing these patient encounters as mini-training opportunities. The result of this approach is real-time learning that one can apply at the time of care. I get to share my knowledge and my staff knowledge and experience continues to grow. Surprisingly, my patients love it and they have become more engaged partners in their own care.
Reexamining Office Processses For Appointment Scheduling And Cancellations
When it came to processes I had in place prior to the shutdown, they too needed some work. I was happy to have some extra time to work on these processes. Some of the things I reassessed included patient scheduling, cancellations, no-shows and appointment reminders. Prior to the pandemic, I had volunteers making appointment reminder calls. Patients received these calls very well, especially when they learned that one of the ladies calling was my mother-in-law. However, when COVID-19 hit, I did not want her to be at greater risk so she has not yet returned, unfortunately for her and the patients used to hearing her cheerful calls. My electronic health record (EHR) system has e-mail appointment reminders but some calls were still necessary. At the end of last year, I found a system that I can add to my EHR system to better automate this task. It also worked out that during this time that we collected more email addresses and cell phone numbers than we ever did in the past.
There seems to be a small bright side in all of this tragedy. We are now completely paperless in our patient registration process. More patients understand and are willing to complete their medical history from home, allowing them to have less contact at the office and less need to present early for the visit to complete paperwork. Thank goodness for my HER system that allows patients to fill all the necessary demographic and medical, social, surgical history from home. All of this information is imported into their patient note with the click of one button by my medical assistant. She then just has to verify the information when the patient comes into the office. I review the information, verify a few things and only have to document my exam, plan and orders. I get all my notes done within three minutes of seeing the patient and, no, I do not use pre-filled templates. It is just that easy.
Yes, I know we see fewer patients due to the pandemic restrictions but there is a silver lining to this cloud as well, which I will discuss a bit later.
Another process I wanted to look at was how we recalled and captured no-shows and cancelled appointments. Prior to the COVID-19 pandemic, my receptionist was too busy with front desk patient interaction, which made it difficult to focus as much on this aspect of the practice. After we reviewed our process, we reduced our no-show rate to less than one percent. We still have cancellations but we can now use our new tools to recapture these patients to get the care they need despite uncertain circumstances. This also helped us to recapture potential lost revenue and allowed the practice to continue to employ all staff members without reduction of their hours.
The Silver Linings Of Seeing Less Patients
As part of the COVID-19 relief programs for small businesses, I applied for and received Paycheck Protection Program (PPP) funding the first time around. I used the PPP funds appropriately and all of the loans were forgiven after submitting the necessary documentation. Near the end of last year and earlier this month, the new round of PPP funding became available. I looked to see if my practice would be eligible by having a loss of income of at least 25 percent in any of the four quarters of 2020 compared to 2019. Well, I was a bit shocked to learn that not only did we not have such a reduction, we in fact had an increase in revenue every quarter. So I won’t be able to apply for the next round of the Paycheck Protection Program.
I decided to look further into why or how we achieved this remarkable upturn despite weeks of lockdowns and decreased patient volume. It turns out that it was concentrating on giving comprehensive care to patients who needed to come in and making sure we saw our patients with diabetes with or without wounds so they had less complications.
This translated to patients being happier about the care they received. We even surpassed our new patient volume goal we set at the beginning of the year. My surgical volume also increased even though we had many weeks when the hospital did not allow elective procedures. I still saw patients in the office who needed surgery and we had a system in place to get these surgeries scheduled as soon as the hospitals would let us. We also brought in new quality products that I often prescribed and dispensed for patient convenience during this time so patients did not have to run around town looking for items. Our orthotic (both prefabricated and custom) treatment plans did not suffer during this period either.
Earlier, I said there is a silver lining in seeing less patients. I used the opportunity to really listen to patients and make notes of all foot ailments they had questions about. I would answer these questions and then I would ask patients if there were any other questions they had. This gave me the opportunity to give advice, education and treatment plans to answer all of the patient’s concerns. No, I did not spend an hour with each patient. I spent no more time than I had previously but with our new processes in place, the staff was prepared to help me address each condition more thoroughly. It is truly rewarding for us to know we make patients more satisfied. I hear many patients tell me “I should have done this earlier.”
Educating Referring Docs And Patients
I began an internal marketing program in January 2020. Of course, on March 12, 2020, everything changed. I could have given up this idea but I kept going. Every month, I sent out patient newsletters on different topics. I continued to take physician-oriented newsletters every month to the offices of current and potential referring physicians, even if I could not meet them personally. After six months, I had them calling to ask me about the status of the next issue.
We also continued to post a “Condition of the Month” flyer in the treatment rooms. At first, I did not think anyone really read it but patients ask me “is that what I have?” and point to the placard posted by the treatment chair. I even have patients asking for additional patient newsletters to give to community groups or neighbors.
Patients appreciate the little bit of perceived extra time as we currently only have two to three patients in the office at one time. Sometimes, I can address all of their complaints on one visit. Other times, we schedule a follow up to check on the current treatment and then address a few more items on their list.
Patients also appreciate that we created and ensured an environment as safe as possible for them in the office. They are aware that telemedicine is available for quick checks or to discuss test results. They also comment that steps to put technologies such as automated reminders, text messaging and paperless workflow into place contribute to the ease of staying in contact. Even the pens we provide patients with are stamped with our practice name and contact information with a foam tip stylus compatible with tablets or phones. We tell patients to keep the pen to prevent contact spread and we do not have to clean them. It is a marketing tool with multiple benefits for all.
In closing, the biggest takeaway for myself and my staff is a reaffirmation of the importance of our relationships with our patient population and the community as a whole. Medicine and our practices can offer a safe harbor during rough seas for our patients as we can continue to address their medical needs and provide a place for them to voice their personal fears during uncertain times.
Dr. Aung is Chief of the Podiatry Section of the Tenet Health System/St. Joseph’s Hospital in Tucson, Ariz. She is a member of the APMA Coding Committee, the APMA MACRA/MIPS Task Force and is on the Exam Committee of the American Board of Wound Management. Dr. Aung is also on the Editorial Review Board for Wound Management and Prevention. Her website is www.healthy-feet.com.
1. Aung B. How Will This Uncertain Time Define You? Podiatry Today. Available at: https://www.podiatrytoday.com/blogged/how-will-uncertain-time-define-you . Published April 8, 2020. Accessed February 16, 2021.