Episode 35: COVID-19 Business Effects for Practices

Practices are scrambling to understand the business effects of COVID-19. Scott, Michael, and Jared point to examples of how practices are communicating with patients, updating their websites, and dealing with other business ramifications of the pandemic. Amid the whirlwind of changes, there are bright spots of hope for providers and patients alike.

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Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans and many of those humans have unbelievable stories to tell.

Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together and here’s some amazing stories along the way. Ready for a breath of fresh air? It’s time for your paradigm shift.

Michael: Welcome to the “Paradigm Shift of Healthcare” and thank you for listening. I’m Michael Roberts with my cohosts, Jared Johnson and Scott Zeitzer. On today’s episode, we’re talking about how practices are dealing with the current pandemic. Last week on our website, we put together a guide to demonstrate how practices are updating their websites and their communications to get the messages across to patients during this time. But obviously, there’s a whole lot more happening with practices as everybody is dealing with the fact that there’s a global pandemic happening.

So, today, I’d like for us, the three of us here on the show, to talk about the following, one being how practices are communicating, because that’s kind of a flow of what we’ve already been seeing. But then, two, what practices are going through from a business perspective because it’s not just the communication aspect that’s changing obviously. What surgeons are doing differently during this time and how all of this, these first three things, either match or contrast what’s happening with the larger world of healthcare.

So, guys, that’s, kind of, the table that we’re gonna be sitting at for this conversation. Let’s jump in. How practices are communicating. What have you guys seen and how is that happening where you’re at?

Scott: I’ve spoken to approximately three dozen practices over the past couple of weeks and a lot of the conversation is how to get something on their website, which basically says either we’re only gonna take care of you via some sort of telemedicine option, or if they are seeing any patients, what steps they’re taking to see patients, and it’s usually extremely spread out directly into the waiting room. There is no waiting room at all, really. It’s, excuse me, it’s directly into the examination rooms. So, and that’s a select few of people that I’ve spoken with.

Most of the orthopedic surgeons and spine surgeons that I’ve been speaking with are trying their best just to take care of their patients, either over the phone or via video.

Michael: Yeah, absolutely. We’ve had some different ways that we’ve even been trying to help practices get some sort of idea because a lot of, you know, when all this first started, everybody gets this sense of, like, “Geez, I just need to get this message on there. What do you guys think?” And that’s really where a lot of that first blog post came together around, “Hey, here’s some good templates you can follow. Here’s some different ways that you can go.”

But it’s interesting seeing, from that initial need for communication to now we’re getting conversations about, hey, like, there’s a pediatric group that we work with and they’re trying to figure out, “How do we most effectively get across to patients that they shouldn’t go to the ER if they need to see our services, they should go here instead? And here’s a different process that we’re trying to follow.”

And so, there’s this interesting shift in, “Hey, we got through the initial wave of this in terms of just communication, but what do we do now? How do we communicate to practices? How do we communicate to patients, now that we really need to in an ongoing way?” And so, that’s a very interesting set of problems that people are facing.

Scott: Yeah, I’ve seen that. You know, like you said, Michael, we had a variety of ways to highlight that, “Don’t come in for your appointment,” as a standard operating procedure and “call this number instead,” that kind of thing. There’s the triage effect taking place, “Just don’t come in.” And now, a lot of these surgeons are trying to figure out, “Well, how do I take care of my patients? They’re in pain.” You know, people don’t go to the orthopedic surgeon for fun. People don’t go to the spine person because their back feels great. They’re in pain. And they’re trying their best to figure out how to handle that.

And regarding the Children’s Orthopedic practice we were talking to, kids fall down, you know? Pediatric orthopedics is all about, a lot about, I should say, children falling down while playing. And thankfully, I’m hoping that lots of kids are still figuring out a way to play. And I really was very happy to see how hard a lot of these surgeons were trying to figure out just how to take care of their patients and keep them out of the ER. The ERs are overwhelmed. We all know that. So, keeping them out of the ER and helping by keeping them out of the ER is, I think, it’d be critical for not only for their own patients but for just the general population as a whole.

Jared: Yeah. Scott, some of the considerations that I’m seeing teams having to make are…is realizing that when it’s something specific about, “Hey, is my surgery that was scheduled, is that still on?” And so, that’s such a personal thing, you know. People aren’t googling that. They’re probably contacting the doctor themselves, the practice, the doctor, the surgery center, or whatever, directly itself.

And so, first point is to realize those points. Like, let’s just make sure all those are very consistent in exactly what they say and be very clear. And if there are alternatives like Montefiore Orthopedics up in the New York area, their site just has a really clear look, “All elective surgeries are postponed. And here’s the alternative. We’d love to see you on a video visit. Here’s the link. Here’s the number to call.” It just comes right out and says it right at the top of the page.

I know some of the examples that you gave on your website, of the list that you gave of landing page things that you’re seeing, echo that sentiment too. But the thought is just being really clear and understanding what those questions are because that’s the difference between the questions somebody is trying to google or find out from the CDC or their local large health system as opposed to, you know, a practice about a specific procedure that’s on the books.

Scott: Absolutely. So, there’s that specific procedure that, of course, more than likely they’re not gonna get, and then, “Okay, I’m not gonna get that, but I’m in a lot of pain. What do I do?” We’ve spoken, I know, Michael, you have, I know I have as well, to a lot of surgeons about different telemedicine options, different ways that they can communicate, I’m happy to hear that the federal government basically loosened any kind of telemedicine HIPAA requirements. I believe that doctors, surgeons, etc., can all talk on something as basic as FaceTime just to take care of the patients.

And while you were talking about Montefiore, when Montefiore put that big magenta banner across the top of its website, that was before the wave really hit New York. New York is in the middle of a real crisis right now as the pandemic is sweeping through the New York metropolitan area. And I know that Dr. Kirschenbaum, who’s in The Bronx as well, Montefiore’s is in a little bit more Northern area of The Bronx and where Dr. Kirschenbaum works, he’s in BronxCare, Bronx-Lebanon, and their orthopedic team basically set up another place within the hospital to take care of orthopedic trauma issues, just to get them out of the ER. You know, everybody coming into the ER, obviously, the bulk is the coronavirus issue. And if somebody came in, I don’t think anybody’s really coming in with a twisted ankle anymore, but hey, you can break your ankle and you’ve gotta be seen.

And so, at that hospital, Dr. Kirschenbaum and their team actually created a separate area, like, “Get him out of that ER and into our ‘ER,’” so that they could take care of the patients in a separate area. And I’m gonna guarantee you, a lot of other hospitals are dealing with that internally. You know, how they communicate, “Don’t go to the ER, go here instead.” That’s exactly what the Children’s Orthopedic group did. “Don’t go to the ER, come here. We’ll take care of you.”

Jared: Yeah, I just spoke with Andy Gradle who, for many years, was in the Philadelphia area. I think he’s still in the Philadelphia area. He’s on the agency side now, just over the last year or so, but for well over a decade, was in the trenches with digital teams at large health systems. So, he would have been the one responsible for that, in this case, that COVID-19 resource page.

And he made a real interesting point to me just the other day about how it’s just as important to realize what not to put on that page, or at least not what to emphasize, you know.

Scott: Sure.

Jared: Because generally speaking, we’re not going to certain places to look for the really basic information about how the virus is spread. You’re probably googling that and clicking on the CDC site, you know, the WHO, the NIH, you know, so a .gov site, a very clearly trusted site that is authoritative for the basics about the virus. You know, how is it spread? What is it? What’s the incubation period? Those kinds of things. They’re probably not going to the practice site. If they’re already there and they have questions about it, then that’s one thing, but that’s probably not the starting point. And so, that doesn’t need, you know, this isn’t a Wikipedia entry on your page, on your site.

It is answering those most frequently asked questions, which usually are, “The thing that I have scheduled with you, what’s the alternative?” Like you said, if I’m in pain because that was canceled or postponed, what happens next? Who do I contact? What do I do? What are my options? And so, to have seen a lot of landing pages with that information right at the top, that’s really useful to know. Just to realize you don’t have to start with, “What is COVID-19?” I mean, the world knows what it is now so that doesn’t need to be the first thing on your page.

Scott: It really is about very specific things to their practice, to their patients that need to be on the websites. It’s what we’ve focused on. I think, Michael, if I’m not mistaken, we put up a LinkedIn article for people to maybe help them a bit with that.

Michael: With LinkedIn, we’ve got some information there. And then, also, you know, if you’re beyond just orthopedics, beyond just, you know, the very specific areas that we cover.

Scott: Sure.

Michael: I was on Twitter yesterday and jumping out there and saying like, “Hey, you know, who out there is doing a great job of it?” And of course, like, those leading healthcare providers that you expect, MD Anderson, Cleveland Clinic, like, these organizations have really tremendous pages that get into, “This is what you need to know about coming here. This is about whether or not you should come in or not. This is…” All of that sort of information.

MD Anderson, in particular, Joe from the HCLDR Twitter chat, he volunteered their page and they actually responded and said, like, “Hey, you know, this is what we’re doing to try and get out in front of it.” And they’re doing daily videos even, so it’s one of the leading doctors there on the team is getting out there and saying, like, “This is how we’re handling it today. This is the latest that you can expect.”

Obviously, not every kind of practice, not every kind of group that’s out there can communicate at that extent, but it’s amazing how fast this information has become dated. You know, all of us are doing some sort of, like, ongoing reading about, like, what’s the newest thing? And it’s so funny because there’s all these leading organizations out there that are putting out really in-depth thought pieces and they’re so great for the moment, you know?  “The Atlantic” has wonderful pieces, and “The New Yorker,” and all these different pieces. And it’s like, if it’s a week old at this point, it’s so outdated. Like, the world has changed dramatically since last Thursday. And so, what’s going on right now?

And I think that’s another opportunity for practices, for larger organizations, you have to keep communicating all the way through this process.

Scott: Which kinda is a good segue to the second conversation point, which was, you know, what are practice is going through from a business perspective. So, you know, from a triage level, it’s like let’s let everybody know exactly what we’re doing, right? And so, if you’re MD Anderson, you’ve got a lot more complex communication issue than you do if you’re, you know, Dr. Smith on Main Street, you know?

It’s basically, like, “Here’s what I’m doing and here’s what I’m not doing and here’s the number.” And that’s good. That’s exactly what you need to have, to Jared’s point, you don’t need to have a lot of information about COVID-19. You need to have just very specific detailed information about how to get a hold of the doctor.

But from a business perspective, it’s interesting. Some of the initial…I remember speaking to some surgeons, like, really before it happened. And what I mean by that is you read that it’s about to happen. Everybody will see, like, if you were in the New York area, and I’m in New Orleans, one of the epicenters, that’s where Michael and I are, you basically read, like, “Wow, it’s gonna get really bad soon.” And you don’t know what that really means. In fairness to everybody, no one’s been through this before.

And so, you start thinking about what you’re gonna do. And a lot of the urgents that I spoke to before, it really hit, that wave of patients coming into ERs. There were some orthopods who are, like, you know, “Maybe I could take care of people in the ASC,” and then they quickly realized that’s crazy. That’s not gonna happen. Like, I get that we need to take care of a fracture and we’ll figure out how to handle that, but I can’t imagine any orthopod right now thinking about, you know, doing a total joint at Ambulatory Surgical Center. They’re taking away masks. I mean, it’s that simple.

But now that you’re starting to ride that wave, so to speak, what do you do as a prac? I mean, there’s a lot of open questions there. As everybody knows, we deal a lot with orthopedic surgeons and spine surgeons. And they do pretty well from a financial perspective, say, relative to a pediatrician. There are a lot of business decisions that they are being forced to make right now that they never thought about.

Michael: There’s a lot of interesting news right now happening where we’re seeing things about this group is furloughing this amount of people or this amount of staff is being permanently laid off and this… Yeah, you’re right. Like, this is not the norm. This is nothing, nothing like this before. And so, there’s this interesting thing where practices are having to go through these major changes and maybe some of the communication that this particular staff member initiated and started updating on the site, updating with the public and on all of those sorts of things, maybe that person’s now on furlough, maybe that person had to…is no longer there. And so, who’s now handling that? Is the surgeon having to pick that up? Is another administrator having to pick that up?

So, there’s just…there’s a lot of things that are suddenly in the air that nobody’s necessarily really there to catch just yet and they’re having to figure all that out on the fly.

Scott: Yeah. And like everybody, I mean, nobody knows when things return to “normal.” When I say normal, I’ll put up my finger quotes up there. So, there is no new norm-. It’s gonna be a new normal. If you look to other countries that have already experienced this pandemic, and I’m thinking mostly Asia, they tried to open up stuff a little bit too quickly and they had to reclamp down. It’s unfortunate.

So, how we reopen for business, both as a country and then down to somebody’s practice, that is going to be an interesting curveball that’s coming to everybody. I do know one thing, every doctor and surgeon that I’ve spoken to all are very aware that their patients, their pain is not going away. So, three months from now, six months from now, I don’t know when, there is gonna be a backlog of people needing help, you know, in person.

I don’t mean, like, “Doc, it really hurts. What do I do?” I mean, “I need surgery or I need some sort of care,” etc. And that’s gonna be…put a lot of pressure on practices as well because, just like you said, they just furloughed a lot of people. How do they bring those people back on? How quickly do you bring them back on? How do you manage all these patients that are in pain? And by the way, they’re all gonna be exhausted.

Jared: So, Scott, from the surgeons you’re speaking with, are any of them being called in to help on the front lines anywhere? I mean, they’re not exactly sitting around twiddling their thumbs.

Scott: It’s interesting you bring that up. I really do think it kind of depends. I know, again, in New York City and then in the New York Tristate area where the pandemic is very high, it really is all hands on deck. I don’t think you’re gonna see an orthopedic surgeon, say, managing the ICU. They’re, kind of, far removed from that. But I could certainly see orthopedic surgeons just trying to get people out of the ER, you know, so they could take care of those patients that need that type of help.

I know that a lot of internists, OB-GYNs, people who haven’t really taken care of COVID, who wouldn’t be the ones responsible, are all helping. There are a lot of doctors, nurses, cleaning staff that are all just working long, long shifts, just trying to manage it.

Here, in New Orleans, it’s the same thing, all hands-on deck. And remember, we are going to run out of supplies. And so, there are a lot of people who are seeing patients that aren’t protected as they should be. They’re getting COVID and then they’ve got to sit out for 14 days, if they’re lucky.

Jared: What I’ve seen is so many of those I’d consider support staff or supporting service providers, agencies, vendors, suppliers who have found ways to be involved. And this is one of the most encouraging parts in the midst of a very dark situation that we’re all going through right now. But it’s…so I’m looking for these bright spots, these little points of encouragement. Because, my goodness, I mean, we’re just going to…it’s gonna be very challenging if we don’t see them and hear about them.

But there’s a local mattress company here in the Phoenix area, for example, that is starting to make hospital beds. They had already, in the past, they had already figured out how to make the covers, they just never sold them commercially. But they’re like…and then they also were able to turn part of their manufacturing facility into manufacturing masks, and then they were looking for somebody with the material. And then there was another company in town, a med-tech company that said, “We have material for N95 masks, we just need the manufacturing facilities.” And those two were able to collaborate.

I mean, these are just folks who never would ordinarily be involved and they are doing so and they’re finding ways to do that. And there are doctors by the tens of thousands coming out of retirement to help and, you know, so all of this. I like finding those bright spots. Because the other side of this reality is the latest number I’ve heard, and I think you’re right, Michael. These numbers changed by the day, by the hour. So, who knows if this number will still be accurate. But the number I heard yesterday was the hospitals are anticipating losing 25% of the revenue, in general, this year because of the outbreak. So, right there, like, that can send you in a tailspin thinking about what does that mean.

And you know, I feel like a practice has an opportunity to have that make less of mark overall in the year because you can make up and find ways to schedule, hopefully, later in the year, you know, where all this pivots on the hope that we can get out of this sometime, you know, maybe in the summertime, you know, before too long.  So, again, nobody knows for sure, but just all the things I think that we’re all trying to figure out now and later. I can see how heavy that weighs on people and that’s why it’s nice to hear some bright spots about some of those who are turning, I guess, finding ways to be involved.

Scott: Yeah. Yeah. I know that there are a lot of people out there trying to help out and ultimately maybe that’ll make things a little bit better for everybody. I mean, along those lines, you know, what are surgeons doing differently now, you know? And some of them are helping out, you know, on the front lines, some of them are helping to manage ERs like they used to. You know, most surgeons were in the ER for quite a while. As I mentioned, like with Dr. Kirschenbaum trying to get people out of the ER and where they need to go, if they’re not COVID, and taking care of them.

So, there’s the medical side of what they’re doing and then there’s the business side of what they’re doing. And again, a lot of those surgeons, when they had their business hat on are starting to say, like, “Hey, in three months, in six months, I need to be prepared for this and how do I attack the market so that people know how to find me?” It is gonna be important as well. And so, surgeons don’t do a good job of sitting down. They’re Type A, OCD nuts. And I say that with love. I want a Type A OCD nut to take care of me if I’m in trouble in the operating room.

So, a lot of them are working really hard trying to help wherever they can and then they’re coming home, trying to figure out, like, “How do I get my business reserve resurrected, you know, when all this settles down?” And a lot of them are starting to think about how to get their messages out more effectively so that they could get those patients, attract those right patients, get them in, take care of them, and move on to the next one. Because that’s what’s gonna happen next, for sure.

Michael: It’s really interesting seeing how unevenly the nation is going through this. You know, we do have those surgeons that they are completely busy, they’ve got no time because they are helping out in all these different ways. And then you’ve got some areas of the country that this hasn’t exploded, you know, in the same way, or this isn’t as pressing an issue or, you know, there’s a lot of different factors there.

And so, some people are getting the time to think more and to think about, like, what’s the next step for them and what do we do when we come out of this. One of our former guests on this show, Dan Dunlop, was writing about what health systems need to be thinking about from a healthcare communications, healthcare marketing kind of standpoint. And, you know, this business aspect that you’re talking about, Scott, really resonates with what he was kind of saying, like, “Hey, there is a post-pandemic plan that needs to be happening,” you know? Like, I get it. Not everybody can do that at the same speed and not everybody has the availability to, but there is going to be another side of this. There’s going to be a post side of this. What do we do at that point?

And so, it’s interesting because you can’t just, again, you can’t just go back to normal. Well, I was going to talk about the blah blah blah thing and so now, I’ll just, like, roll it right back out. I think you’re talking about, you just unpause the campaigns so everything’s fine. It’s like, “No, the world is not okay with you unpausing whatever it is you had going on before.”

Jared: No. Exactly. And I think that there will be some hypersensitivity to that. So, we won’t be out of the woods when the smoke clears and restrictions are lifted and we get back to some…whatever the new normal is, we won’t be able to just unpause things. And I think it’s worth emphasizing. And so, the thought of just starting now, recognizing that people might need help just understanding, like, what is someone else doing but also what do I even need to think about? Like, what are the things we do know for sure? We do know for sure…

That’s a good question. I don’t know but what they’ll have for sure, I was about to say, we’ll know that we offer these services. And I’m like, “Yeah, that’s not even clear.”

Scott: No.

Jared: Like, some services are probably gonna change for just what every provider and every practice and every health system out there. And they’re probably incorporating more virtual visits. They’re gonna have to, like, that’s not going away. That’s not changing. If anything, we’re just gonna have to figure out how to work that in. And so, man, like, yeah, square one, it seems like.

Scott: Yeah, I think it’s all going to be, in all sincerity, a lot of trial and error. There is not gonna be a “normal.” There’ll be a new normal. You mentioned “The Atlantic” being a good source of information.

Michael: In one area. Yeah. And it’s like how many, like, hundreds of pizzas that they’re just giving away right now. And just to get in the front of hospital workers, try to take care of people. And people are finding ways to be good and finding ways to, you know, be a part of this and really help. And so, there is a lot of beauty and there is a lot of encouragement out there, but it’s harder to find for sure.

So, we just hope, listeners, that you get the chance to, kind of, cling to that, cling to those things that are happening well, and do think about what’s going on with your business, think about what’s going on with how you take care of patients. And we look forward to talking with you more about this. Thanks so much, guys. Really appreciate the show today and look forward to next time.

Announcer: Thanks again for tuning in to the “Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neuro practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.