Okay, my disclosure slide. And then our first polling question on this topic, did your practice close or have a decrease in patient volume? Please select one, yes or no. 100%. Okay. Next question, did your practice decrease staff during the pandemic? Please select one, yes or no. Okay, so 80% or so. And last question, is your staff back to pre-COVID levels? Yes or no? Please select one. Okay, so about three-fourths of our practices are back to pre-COVID levels. Okay. So when we talk about the practice, medical practice staff, I find it useful to think about sort of different regions within the practice, the front office staff, the clinic staff where patients are seen, the back office staff, the providers, and the management team. So we all know that COVID led to practice closure or decreased patient volume as evidenced by our snapshot poll here. As a result, many medical practices lost revenue and many practices temporarily decreased staff either due to furloughs and layoffs or staff stayed home, or some actually quit, and that was certainly the case in our practice. During the initial recovery, patient volumes increased and more staff was needed. We heard from Randy that even though staffing levels and patient volumes weren't back to the level that they were before COVID, the workload in many ways has actually increased. And so the question remains, how can we bring staff back and keep staff in the practice and do it safely, particularly given the challenging time of the ups and downs of COVID? I mean, we are in a recovery phase, as Randy said, but we're still in the middle of the crisis, particularly given what's happened the last couple of weeks, numbers-wise, across the country. So this slide lists some of the key challenges during COVID-19. Staff downsized due to decreased patient visits, alternative and adjusted work schedules, creative options. Sick employees are caring for sick family members. Employees off due to childcare issues. This is a very major factor in terms of staffing during the pandemic for most practices. In some locations of the country, schools are all online and others are hybrid models. So those implications impact the practice in terms of staffing as well. Employee hour reduction, workforce reduction, significant difficulties in hiring new staff at, frankly, all levels of the practice, not just front office, but also in the clinical area and even in billing. And the process of returning to work, how is it defined? Social distancing in the workplace, a lot of factors to consider in that realm as well. So as I was putting this talk together, I wanted to include this slide, which is a word cloud of some of the key words to think about as we're bringing our staff back. And you'll note that resilience is the greatest of the words on this slide. And really, we all have to be resilient as we think about how to bring the staff back, do it safely and how to keep them working with us in the practice. So Deloitte had a wonderful article talking about leadership workforce strategies for COVID. And they break this down into three phases, the respond phase, the recover phase in which we are currently, and the thrive phase, post-recovery, how can we thrive? How can we expand our practice and make it greater than it was pre-COVID? So in this slide, there are some mind shifts to think about when going from respond to recover. When you look at the situation, we go from unpredictable to, quote, interim normal, which is, I think, a great phrase of where we are today. We are clearly not normal, but yet we are not at the beginning of the crisis. In terms of focus, inward looking, changing over to market facing, how can we market our practice to reach all of our current patients and potential new patients? As Randy said, keeping some of the old processes in place while expanding and building up our telehealth options for those patients that absolutely don't want to come to the office unless they have to for an exam. Management, we have to move beyond crisis management, which I would submit to you is where we were from March to probably July or August. We have to move on to program management. How can we manage the situation today while thinking about the future and expanding? Planning, contingency planning, to scenario planning, and attitude from reacting, which is what all of us did the first few months of the pandemic, to reinventing, to thinking outside of the box, how can we make our practice better post-COVID? So from recovery to thriving, understanding the required mindset shift, identify and navigate uncertainties and implications, trust. We have to embed trust as a catalyst to recovery. Trust not only with our staff, but also with each other in terms of providers as well as our patients. We have to define the destination and launch the recovery playbook. Where do we see our practice going six and 12 months from now? Granted, when we're looking at the future, it can be difficult not knowing what's around the corner. What is COVID going to look like a month from now? We don't know. But we have to plant the flag, plant the stake, and aim towards that. And we have to learn from each other's successes. I cannot overestimate the importance of trust throughout this whole process. Trust in terms of remembering who we are as a practice, communication and listening to the staff is paramount, encouraging, comforting, and recognizing each other, taking time to relieve stress when one is away from the practice. It's important for everyone in the practice to do that, from the front office person all the way to the manager and the providers. We have to keep our sanity during this crisis. There is some regulatory guidance regarding staffing. The Families First Coronavirus Relief Act provides some guidance for employers, and it's important for everyone to sort of have that in mind and look at that, and especially for your practice administrator. In a poll from the MGMA regarding staffing shortages, now this is back in March, the beginning of the pandemic, 40% out of 1,220 responses had a decrease, and 42% said yes to using a float staff pool or temporary workers, and this was out of 300 responses. And again, most issues related to staffing, the number one factor is due to school closures and childcare issues. It is not because our staff is at home dealing with COVID-19 exposure, although there is some of that, and in the last week or two, that has increased as the numbers go up. But the key factor is childcare issues and school closures. So again, start with patient safety. You have to have a protocol in place to allow your staff to work safely at home. That is, I'm sorry, to have your staff work at the practice. That is paramount, both for their personal safety, secondly, it projects a reflection that you and as a leader of your practice take this responsibility seriously, the staff appreciates that, you're not blowing off the risks of COVID, and thirdly, it's important for our patients as well. Have a policy to handle time off and sick leave, and it may be completely different from what your policy was pre-COVID, but it has to be, given what we're dealing with. Keep an eye on government recommendations. Be sure someone in your practice, whether it's the administrator or managing partner, is keeping up to date with what's coming out of the federal agencies. No workman's compensations policy, have a staff leave due to COVID-19, and plan for the future. Plan for six months from now, 12 months from now. What is the staffing going to look like in your practice? A few additional points, cross-trained personnel on essential business function. This is important even before COVID, but now it's fundamental because a staff person might be exposed to COVID and have to quarantine for two weeks, and that staff person may have been a critical person in your billing office. Well, it's going to be hard to train, first of all, it's going to be hard to hire somebody new and bring them up to speed. It'll be easier to cross-train someone who's already in that billing department to do that essential job. Every staff member in the clinical area should be trained on telehealth, even those that may not directly do it on a daily basis. For the same reason, once again, if you have a key clinical person out because of personal exposure or quarantining because their child was exposed at school, you want to have someone else be able to do that telehealth function so that patients can still be seen. Manage the patient volume, keep an eye on not doing too much, excuse me, as the staff may not be up to speed. And so you have to adjust that on a biweekly or monthly basis. Do we have too many patients scheduled? Do we have not enough patients scheduled? Keep an eye on it. And also consider contacting temporary agencies for positions that need filled immediately when the above options are not viable. In terms of practice employer concerns, will the practice return back to normal? What will the new normal be? Will the staff come back? Will they look for work elsewhere? Will they stay home because of federal payments, which currently is expired? So these are things to consider as you think about your staff. Once again, think about the short term and the long term. Keep the current staff if possible, especially the top skilled staff. It's always more difficult and challenging and costly to train new staff than it is old staff and that is especially true during the pandemic. Be open to staff fears and concerns. Be sure you're listening to what they're saying about COVID because the concerns are all over the place. You have staff that don't believe this is real and they leave your practice and don't wear masks in places where it's not required and you have staff that are extremely concerned and want to work from home. So be attuned to their concerns and address them as honestly as you can. Follow the CDC and State Department of Health COVID guidelines. If the staff don't feel safe coming back to work and we have had a couple over the last few months, work with them if you can. Find an alternative arrangement. Now is not the time to be adamant about your policies, especially if you have a staff person who is fundamentally important to the practice. You may have to think outside the box to allow them to work and to keep them in your practice so you don't lose them. As an employer, there are some things to consider in terms of, you know, if you fire somebody for wrongdoing or not performing well, you don't have to pay unemployment. If they're fired for another reason that they cannot do their job, for example, COVID, there is some gray there. So be sure to know what the rules are in your state and what the federal rules are. And be consistent as best as you can. Have consistent employment policies. In other words, if you offer one staff person to work at home, there should be some consistency there. You don't want to play favorites, if possible, because that does not often sit well with the staff. The truth is most staff are willing to work with you during this crisis. And the key is to negotiate something that's mutually acceptable to the staff and to the practice. So to summarize, define your short-term and long-term staffing needs and continue to evaluate these. Make staff safety a priority. Communicate and listen to your staff. This is fundamental. Work with your staff creatively to fulfill practice and staff's needs. And today's protocols will prepare you for tomorrow's crisis. We just don't know what COVID is going to look like one month from now, let alone six months from now. But we have to use this opportunity to plan for the future. It's interesting that public health in general, public health departments, really did not exist prior to the pandemic in 1918. And that crisis is what led to what we know public health being today. And so we have to use this crisis today, not only to innovate so that we can continue to see patients and manage our staff, but also to plan for the future and be more resilient for what's coming up ahead. Okay. So with that, I will turn things back over to Randy. His presentation is Working From Home, Running the Empty Office. Thank you.

COVID-19 impact

medical practices

staffing challenges

patient volume

resilience