Q&A: Keeping health care practices viable during, after COVID-19

The COVID-19 coronavirus pandemic has put many physician practices in financial danger.

Aimee Greeter, senior vice president of Coker Group, spoke with Medical Economics about ways to stay ahead of the pandemic and what practices can take away from it to offer better care in the future.

This interview has been edited for clarity and length.

Medical Economics: What seems to be the current state of health care?

Aimee Greeter: I would say that the healthcare industry's current state is one of adaptivity. So, we are having to be really, really fluid in our actions, in our decisions, and in our communications right now. Because things are changing very, very rapidly, and we have to adapt to it. So, I would say that activity is the name of the game right now.

MedEc: What do you see being the biggest challenge for practices in the next year or two?

AG: This is really the crystal ball question, I can appreciate that, and I don't know that I have all the answers. But I will say that there are some very real challenges facing practices in the next six months, a year, two years.

I think that patient confidence is probably at an all-time low. So, getting people to come back for their elective cases, for their non-emergent work. Some trends that we're starting to see indicate that patients aren't really that excited about coming back for things that we would have normally considered to be emergent or urgent cases. And so, as people struggle to find the competence to return back to their physician practices, I think we're going to have to work really hard to get them back to a level of comfort over the next six months, a year, two years. I think that there are real ramifications to delaying well care. And I think it's only a matter of time before we start to see that come to fruition. So, how do we address patient confidence now, so that those issues don't continue to compound and we're really dealing with a much sicker population in that one, two-year timeframe?

MedEc: Will COVID-19 precautions and protocols become the norm after the public health crisis has abated?

AG: You know, one of the things that I'm seeing, and this is in the healthcare industry, it's in Americans in general, it's in our global environment; is this sense of fatigue. We've had a lot of conversation in the healthcare industry about resiliency, burnout, and fatigue in the years that preceded this pandemic, but I think we're starting to see that really come to light in the wake of what's been happening now.

We see caregiver burnout, as a very real reaction to what we're experiencing now and I'm wondering how that fatigue is going to manifest itself. In the coming years, are we going to see more early retirements? Are we going to see more physicians changing either their specialty or subspecialty, or location of care to where they're not interested in having long calls anymore. Call was a long time ago, seen as the way that physician can get their patients in the door and now, I think so many of our physicians, just see the call as yet another burden as part of their day, and there are some that may not feel like that, but a lot do. I wonder if this fatigue that I see starting to set in now is really going to continue into the future and lead to a really changing provider base at a time when we can't train enough physicians in certain specialties. Is this really going to compound that issue to where we have less and less of the physicians that we need across specific specialties?

MedEc: What can a practice leader do to keep their practice viable during the pandemic?

AG: I think it is a difficult time. I mean, we are seeing questions about reimbursement for telehealth that are starting to percolate. So, people have made a big switch and invested, in some cases heavily, in technology that they've never had before, on the assumption that there is going to be reimbursement for telehealth, solid reimbursement and lasting reimbursement. And is that really going to be the case going forward? I know that there's a lot of discussions, and certainly a lot of lobbyists on the hill that are pushing for that right now to continue. But I think that's a question that we have.

So, does it make sense for practices to overleveraged themselves in telehealth, when that may not be a recipe for financial success into the future? That's one thing I would say: Don't put yourself in a situation where you can't be viable. Without a really robust and well paid for telehealth program, I think that's a gamble that I personally wouldn't want to make.

One of the things that we also need to think about is: What is the actual physical plan of a practice going to look like going forward? Even if we move a slice of our pie over to telehealth or to some alternative setting, does that mean that we still need as much space for our physician practices previously? A lot of physicians invested in real estate; they don't they're building, or they could occupy it, or they could sublet parts of it; and that was seen as a solid, lasting investment. But now, if that space isn't needed by you, and it's not necessarily needed by another clinician or some other provider, is that a good strategy anymore? We're starting to see people really scale back on their plans either for owning real estate, or investing in independent real estate, or even occupying as much real estate as they have. I have a client who's been talking about the fact that they really are invested in a goal of providing care, at least 20 percent of it in an alternative setting to their current practice site.

And so, if you think about telehealth or sniffs, or nursing homes being some of the major areas where you're going to provide care, then you don't need that physical space that you want to have. And so being really cautious about your real estate decisions is something else. I think, practices have to be mindful of real estate isn't inexpensive. And so how do we make sure that we're making wise financial decisions about our real estate?

MedEc: How can practice leaders anticipate challenges before they become problems for their practice?

AG: So, I've been writing a series for my own volition that talks about crisis leadership, and one of the things that I talk about in this series is: Are you a thermostat? Or are you a thermometer? The analogy carries that you're a thermostat when you're really setting the temperature in your organization, and you're a thermometer if you're really reading the temperature. I think it's a best-case scenario for leaders to always be that thermostat, to really help set the direction that your organization is going, make sure you're setting the culture, doing all those things to make sure that you're doing, as a leader, the things that you need to do.

But I will say it is imperative that you have a sprinkling of thermometers also throughout your organization. So, your thermometers are going to be your people who are doing the reading of the temperature in the organization, and then carrying back to you what it looks like on an individual person level, on a departmental level across the wider enterprise. I think practice leaders need take more frequent reads from those thermometers and hearing what the people are saying in the organization. What are their fears? What are their concerns? What are they seeing on the front lines that gives them a little bit of pause? If you can take all those data points and aggregate them, you're going to have a much better understanding of what's pressing now and what is starting to really become an issue that's bubbling up to the surface. If you can keep your ear to those thermometers, hear what they're saying, what trends you start to hear from them about what they're seeing, I think you'll be really well positioned to be responsive before it becomes this massive volcanic issue. Catch the problems when they're small, so that you can then adapt to them while they're relatively easy to manage.

MedEc: What would you like to see continue in health care into the post COVID world?

AG: I really like the sense of patient centered ness that we've been having recently, and part of that is just our opportunity to respond to patient needs to build that confidence, as I talked about earlier. But I really like thinking about what our patients need before they even walk in our door; giving them the resources that they need to get them comfortable with what services they're procuring at that time. I think if we put ourselves in that position to think about what's easiest for patients, what's best for patients, what's cheapest, in some cases, for patients; that's really what's going to help lead us to future success. If we really center ourselves on our patient, and in a way that is genuine and meaningful, and not just lip service, but something that we really think about.

There's this concept of putting whatever, whoever the target audience is at the center, and then thinking about what it looks like from that perspective. And I think if we truly did that in healthcare, and if we walked the walk of one of our patients, we may see some glaring opportunities for changes. If we can be genuine in addressing those, recognizing them, admitting that they exist, and then adapting around them, I think that would be a wonderful thing for our industry. So, I would love to see that continue to be ratcheted way up as time goes on.

MedEc: Is there anything else you want to add or anything you think I'm overlooking?

AG: I would say: as leaders right now, it is a tough situation. Some of the thought leadership that's come out has talked about the double shift, people that work all day and then have families that they need to take care of in the evenings. So, this thought of working way more hours than you ever have, either in a traditional professional environment or on caregiving and domestic responsibilities is real.

Just be gentle with yourselves, and be gentle with other leaders, because there are so many things going on in people's lives right now.I think that a little bit of compassion and a little bit of kindness can go a long way. I think it differentiates us as people and as leaders. Be gentle on yourself and be gentle on the others around you. I think it'll be really impactful during this time and, hopefully, that could be a trend that we could continue to see into the future as well.