The next talk is going to be dwelling on a lot of these KPIs and see what data we have available. And we're going to see how can we put these pieces together. So let's get some questions first. Did your organization seize operations for any period of time due to the impact of COVID-19? Oh, that's interesting. That's a good snapshot of the problem with COVID-19. Let's go to the second question. Did your organization continue to provide services but experienced diminished capacity due to COVID-19? So yeah, I mean, that goes along the lines of the data we had available. And we're going to go over some of that data in this talk. We can probably go to the next question. Your organization experienced no noticeable impact. I think this is kind of a redundant because we probably went through that previously. So if you had no noticeable impact on COVID, because of COVID-19 on your capacity. All right. Let's go to the talk and let's look at some of the data we have available. Putting the pieces together, analyzing what we are seeing to build better. This is a two-part talk. Initially, we will look at some of the data from the GI operations benchmarking survey to see how COVID-19 has affected various aspects of GI practice. And then we are going to look at various innovative ways or things that can be done to improve and build it better. GI operations benchmarking survey is an ASG initiative where the data from GI units that are participating in this survey is collected. There are a number of benefits to this survey because it analyzes the trend in unit's operational and financial performance from year to year. You can compare key operational patient procedures, personnel, and financial matrix. And also benchmark your unit's data against the entire study or like units. It can identify the opportunities for performance improvement. The participation is free. If you participate in this data, you will get all those data sets and that you can use to improve your unit's performance. This set of data is based on the survey that was sent due to COVID-19 effects. There were 98 respondents to these questions. Eight were hospitals, 12 were academic institutions, 11 were office-based operations, and 67 ASCs. Based on the survey, you can see there was interruption of services across the board. The extent was highest among the ASCs or the hospital-based procedures, but everyone was affected and their services were interrupted. Collectively, if you look at the data from the hospitals who have the service interruption, there was 32 weeks of collective hospital service interruption. And the breakdown shows that actually two hospitals out of five had 10 consecutive weeks. One reported six consecutive weeks and the other two reported three consecutive weeks. Among the academic institutions, there was a collective loss of 23 weeks of services or diminished capacity. Five academic institutions who had reported this interruption of service, one reported service interruption for eight weeks, one reported for six, two for four weeks, and one for one consecutive week. As far as the office-based operations are concerned, there were six office-based operations that reported interruption of services, and their collective loss of service or diminished capacity was 42 weeks. One reported nine, one eight, one seven, and three other reported six consecutive weeks of interrupted service. Military surgery centers were the biggest affectee of this interruption of service, and 66% of them did respond that they had a major loss of capacity in weeks. And if you look at that data, you can see it ranges from two weeks to up to 12 weeks of consecutive loss of capacity. This is an interesting data set that actually shows how long it takes for ramping back up the services after the interruption. So, at week eight, 50% of the units had regained 100% of their capacity. One unit reached 100% capacity at week four, maintained through week eight. One unit reached 100% capacity at week seven, and one unit reached at week five. This is the same data set for the hospital units, and at week seven, 50% of the units had regained 100% of capacity. One unit reached 100% capacity at week five, and one unit at week seven. Looking at office-based units, same data set shows that at week seven, the hospital units shows that at week five, 50% of the units had regained 100% of capacity. If you look at the spread, there is one unit each reaching the 100% capacity at week four, week six, week seven, and one reached 100% at week four, but fell back to 50% at week seven and eight. Yet the ASCs who were affected the most by the interruption of services due to COVID-19 you can see that at week eight, 48% of the units had regained 100% of capacity. If you look at the breakdown, there is an even spread essentially ranging from three units reaching the capacity at week three, two reaching the capacity at week four, then four reaching it by week five, three reaching it by week six, four of these units reaching at week seven, and four more reaching at week eight. This is the graphical representation of the data that has been presented in previous few slides looking at the academic, hospital, office-based practices and ASCs. They're ramping back and reaching the 100% capacity, and how long did it take for them to do that? It is important to look at this data, not just from the historical standpoint what happened, but it can help a practice to plan for the future in case if there is going to be another interruption, what is the financial plan and for how long they should look forward to, to reaching their capacity back to 100%. That is the benefit of having the benchmarking data because it provides that guidance for the future. And this data of restarting the practices is very important for the future for any practice based on their setting, what they have to look forward to. So, this is the data from the practices who had reduced capacity but no service interruption Two hospital units reported eight weeks of reduced capacity, somewhere from 25% to 50%. Six academic units reported reduced capacity, one 80% loss for five weeks, and three reported 25% loss. Six office-based units reported reduced capacity ranging from 16 weeks to eight weeks. So, the matter is that with all these interruptions and loss of capacity has resulted in significant loss of capacity for screening colonoscopy for last one year, which will have a significant negative impact in the preventive services for colon cancer screening. Based on all this data collected through the benchmark survey of service interruption and loss of capacity, we can say that there has been reported 400 weeks of service interruption. Now, this is based on this conservative assumption that the hospitals and the academic units have reduced capacity. This is based on this conservative assumption that the hospitals and the academic units have average of four room of procedure rooms. Office units have average of two procedure rooms and ASC averages about three rooms, where there are eight case per room per day. This is quite a conservative assumption and even then the loss of service or the service interruption is tremendous up to 400 weeks. Based on that conservative estimate, the hospitals lost about 25,000 cases, academic institution lost about 18,000 cases, office-based practices lost 20,000 cases, and ASCs lost about 1.5 million cases. So, in aggregate, the initial interruption from COVID-19 resulted in loss of close to 1.6 million cases. Although this is an assumption, but this is a calculated guess, and this can show the significant impact of initial interruption of COVID-19 on the whole system. So, there was not only interruption and loss of services, but also perceived increase in the cost of business as well, which resulted from increased cost of labor and cost of medication, supplies, and personal protective equipment. And this is a breakdown for all the practices ranging from academic, hospital-based, office-based, and ASCs, and you can see that it has been increased more than 100% in all these categories that can have a significant effect on the finances of the practice as well. Out of this adversity has come opportunity as well, and we have the opportunity to build better. So, to build better, we have to be prepared for it. And how to get prepared for a change, we have to plan. You plan for the change based on what is going on, what could be the future to estimate, and then you make a plan based on that. And then you implement that plan, which is the second part of it, which is the do part. You implement your plan, and then you check it. What are the effects? What are the changes that need to be made? And then based on that analysis, you act again, and you make the changes. So, this strategy helps to bring about the change that is needed to build better. For any practice, there are three integral parts. There is cash flow, which is the money part of it, then there is your patient population, which are, that are your customers, and then there is essential personnel, that's your staff. It is extremely important to look at all these three pieces of the pie if you want to build it better. You have to look at the money part of it, but that is not the full picture. Your patients and your staff, they are as important as the money part of the cash flow is. And as long as all these three parts are kept intact, the practice is stable, and practice integrity will stay intact. This change has brought an opportunity to make your practice more lean. Look at the cash flow, start measuring the KPIs. And we are going to talk about these key indicators, especially from the financial standpoint in the revenue cycle management talk. Also, retaining the staff is an important part of this change as well. A team is as good as its weakest member is, so you have to make sure that you retain your well-trained staff. Streamline the processes. Having processes for all things in the practice are important, and you can streamline them, making it easier for the staff and more efficient. Similarly, maintaining customer service, which is your patient base, is extremely important. Although there are changes going on, but you have to make sure that the patients are being taken care of and their needs are being met. You have to be innovative to improve the cash flow and the patient volume, and make the practice more vibrant in a different way. Chronic disease care management is one of those options that can be utilized as these are team-based services. There are some third parties that provide the solution, but in-house solutions can be created as well. Similarly, there are a number of office-based procedures that can be included into the service, like manometry, hemorrhoid banding, and a number of GI procedures that can be done in the offices. Speciality pharmacy is another revenue-generating venue, which should be explored if it's not already there. Collaborating with the local providers actually improves the healthcare for the patients and also can help to improve the volume for the practice as well. Technology has been one of the biggest opportunities that has come in during this change due to the COVID-19 pandemic, and telehealth is an example of that technology change, where this telehealth was a rare thing. In certain situations, it has become a normal, everyday way of visiting your healthcare provider, and this technology is going to stay here and, in fact, will become more common. So, the practice should have a plan to implement telehealth more profoundly and easily for the patients, should have improved check-in systems where it is easier for the patients to check in, even with contactless check-in through a phone-based app or website. Similarly, there has been increased implementation of technology in revenue cycle management. Use of robotic process automation has decreased the cost, especially from the payroll side, for the claim submission and decreased the denials as well. You need to have a backup plan, especially from the financial standpoint, at least for three months. You need to have a good hold of your payments, debts, break-even point calculation, as well as overhead consolidation. The best way to predict the future is to create it. Where COVID-19 pandemic caused major changes in the way the service is being provided, there has been dramatic increase in the cost due to supply chain squeeze, tight labor market, and financial burdens. Otherwise, there is an opportunity to innovate, embrace the technology, and have a well-rehearsed backup plan. The pandemic is not over yet, so we need to be prepared.

COVID-19 impact

GI practice

benchmarking survey

interruption of services

telehealth