So, now we'd like to hear from all of you in the virtual audience, your questions and your experiences. We'll hold our first Q&A session of the day. Eden, do we have our first question? I see one. Yeah, you certainly have quite a few questions, a lot coming in about remote working. So the first one, they all take a little bit of a different bend. So how do you handle morale of those that want to work at home but can't? That's a really interesting question. And so you may have two circumstances, one where people don't want to work remote and those that want to. And so you think you need to manage that. And that kind of, I think, alludes to the setting expectations from one of my slides. It's important to set those expectations and communicate that, or they need to understand why. For MAs, for example, we have an MA that left, does not live in Denver now, but is willing to work fully remote part time. And she can work the buckets and things that you don't need to do in person. But not everybody can do it. You may lose people that will find an option in another practice. But I think the key is really communicating the why. Why it doesn't make sense or why you can't do it. And then how can you kind of make the work meaningful in other ways? Okay. And our next question, I'm going to do two kind of together because I get the sense there's a little uncertainty about how do you know people are working remotely? It's that trust issue. One of the questions is, what monitoring systems do you utilize for remote call center and schedulers? And then the other question that kind of plays on this theme is, how can you control time spent remotely? Yeah, that's two really good questions. I mean, for the call center, I mean, we're able to, you know, we're set up to look at call volume and the performance metrics for the call center staffs. We've had that in place for some time. And so we can monitor what they're doing, you know, whether they're in the office or in the CBO or remotely. And so you need an ability to understand how they're performing. You know, their time on calls, drop calls, call volume, those types of things. And you know, for the call center, that's one way to understand how they're performing. I think the key is not time. I think the key is performance and productivity. And, you know, the metrics don't have to change just because they're going remote, whether it's the billing staff or the call center staff, how are they performing, right? And how many calls are they taking per day? And is the performance same or the productivity same or better? They may use their time differently. And remember, they're not commuting and they're not chit-chatting and taking breaks in the office. And so they may actually find ways to be more efficient. But if their productivity goes down, you need to understand why that is. So you need to have metrics to follow and understand, you know, if they're falling off, what's happening and how can you help them maybe be more productive and understand, you know, how they can work more successfully remotely. Yeah, let me piggyback on what Rick said. For the call centers, actually, you can monitor based on their, you know, key performance indicator. You can, these things, how many calls being attended, and mostly in our practice, all the calls are recorded. So this is, it's very easy to see how much everyone is working and are they meeting those indicators or not. And that actually helps to see, I mean, you don't even have to be physically there. And actually, we had our call center just temporarily made virtual when the start of the pandemic. And it worked out pretty well. And people are working from their homes and they did what they were supposed to do. And secondly, about monitoring their time, you know, pandemic has presented like an, it's an experiment that has happened, that has been imposed on us. And even before that, for workforce that is not working onsite, it has been seen that actually it's not about the time, it's they are given targets. And if, as long as they're meeting targets, and many a time, they actually work at odd hours to meet their targets. So usually the productivity never goes down as long as they're meeting their targets. And that's how you can monitor how much work is being done. Have you had any outliers where you felt people weren't meeting their targets? And if you did, what was your intervention? For us, as I said, we moved our call center temporarily virtual. It was something new for everyone. And we actually didn't have any problem. But you know, it was very temporary thing. But we really did not have any problem that people were not doing their jobs. And we really thought that the productivity was better. People were at home at ease, and they didn't have to commute and do all of those things. So we really didn't have to deal with that much. We haven't had really that problem either. And it's actually worked really well. But I agree. And Kim, any thoughts from New York? Same for you all? Well, pretty much the same. We don't have very many people at my facility working remote. Pretty much everyone is in the center. So during the COVID time when we were partially shut down, we just had an essential staff at the facility. So really not working with remote staff at the moment. So Dr. Chowdhury and Dr. Rahman, let me just ask a little question. Do you feel that setting the performance targets and kind of empowering people to meet them, has that shifted your leadership style, or is that a complement to the leadership style you already had? I think it's really just an extension of what our managers have been doing. I mean, I think that's the key. And it's easier, as Sufjan alluded to, in certain departments to measure performance may be a little more difficult, right, for your medical assistants, for example, versus like Sufjan noted. I mean, we know exactly what the call center staff is doing, right? And we know how the billers are doing relative to their tasks. So if it's task-oriented, you can follow that. And so I don't know that it's changed, other than it actually makes it a little bit easier to kind of follow their performance when they're not in person. Okay, so our next question is, my docs want remote workers as independent contractors and not employees. Does anyone do this or outsource to India or the Philippines, companies in those countries for virtual assistance? I certainly think that's a possibility. I think, as Sufjan said, this is an experiment. I think everything's on the table. I mean, who knows, right? And so I think we've been really focused on just getting, having successful, we have about 15% that are 100% remote right now of our workforce, but there's certainly opportunities to do things differently, potentially. And so, you know, I think there's definitely certain practices and organizations, medical organizations will potentially do that. Two parts to this question about independent contractors and then having virtual assistance and all this. Our CFO is against independent contractors. I mean, financially, they are like, no, we should not be doing that. We should have full-time employees. So we never tried that. As far as the virtual assistants are concerned, I'll give you an anecdotal experience here. So even before the COVID started, we had hired a service to outsource our call center so that we can have a less burden on our local people who are sitting in the office and after hours, and even when there is call overload, they can take care of them. And they were located in United States, but not locally. We had a great presentation. They had like all the bells and whistles with the computer system, and they can have profile of every physician, what they like to do and all that. It was a terrible experience because, you know, it's public dealing. People, when they call, they want to know, okay, what time I need to come, okay, what road should I take? Should I take the interstate this way or that one? I mean, someone locally sitting there makes a huge difference when people call. And so we had to just shut them down and bring everything back in-house for the same reason that we got complaints on the basis. I mean, it's just how that it works. Okay, we have a raised hand in the audience, so we're going to try and open up a phone line. So Cheryl Murphy, I see you typed in something too, but we see a raised hand. So I have just unmuted your line if you want to try and talk and see if this works. Cheryl, are you there? Oh, it looks like you're still muted, so I have to ask to unmute you. Let's see, unmute. Let's see. Oh, we're trying so hard. Cheryl, are you there? I am, but I'm not sure you're going to be able to hear me. Yeah, we can now. Wonderful. Thank you. This is our first time unmuting, so go right ahead. Good morning. My question was, can you guys share what phone systems you're currently using? We're using a web-based product, and it's not allowing for all of the different functionalities that you're speaking of. So I'm wondering if you'd be willing to share those. I'm not exactly sure, but I can find out. I don't know, Sufian. My answer will be close to what Rick was saying, but I recently had to go through some of the issues people were having. So we have a Nextel-based solution, which is internet-based, plus it's connected to our exchange as well, and you can record all the calls, you can listen to them, and when an MA or a tech is logged into their account through the computer, they have a small window which opens up, and they can just call, and it will ring on their phone, which is next to their desk. So it is kind of an integrated system we use, and it's not like something which is recent. I mean, we've been using it for a very long time, because I don't deal with that on a daily basis, but it works very well. I mean, whenever there is an issue about the call, I mean, we can listen to all the calls. They are recorded. They are kept there for a certain amount of time, and it works well for us. And what I would suggest, and we'll follow up with the physicians on panel and their systems, but anyone in the audience, if you are using something that's working well for you, and you'd like to let us know about it, and we can share that back out with the group, you can go ahead and email practicemanagement, those two words, just as one word, practicemanagement at ASG.org, and we will push that, we'll kind of compile anything folks send to us, and we will push that back out to this audience so we can all learn from each other. So if folks wouldn't mind doing that, that would be wonderful. Our next question is, how do you deal with internet interruption issues for remote scheduling and operator staff? This is a challenge, internet connectivity is also a challenge for telehealth, and so we have an IT team that we work with, and so we've had to troubleshoot that, you know, but it's actually worked pretty well. It hasn't been as much of an issue as we worried about. I mean, most people have good Wi-Fi connectivity. Sometimes it's a challenge if there's a lot of people at home, right, you know, maybe kids from school or a spouse that's working, but we have a team that's been able to address that, but we've done that proactively, and it hasn't been rate limiting in the sense we haven't been unable to kind of make it work for anyone. Yeah, our experience has been similar here. We really did not have any major problems, and most of the times people could use their cell data network, even if they are having some problems with their home internet services. I mean, with our practices, we get a lot of patients or a lot of our employees actually live in kind of rural areas, or there are like big areas like woods and all that, and many times they don't have in those areas the cable internet. They just use their cell networks, and they have worked pretty well. We didn't have any major issues regarding that. Okay, we don't currently have any questions in the queue. I'll remind folks to use the Q&A box, and the Q&A box is preferable to the chat box. That keeps us really well organized. If you want to enter more questions, do any panelists have questions for each other? I would just ask a question to Rick. What strategy have you used to retain your employees or to entice them to stay or get some new ones? Because, you know, we are competing with big hospital systems as well at times. What have you done for that? Yeah, I mean, so we have increased salaries, which I think has helped. We are offering, you know, signing and referral bonuses. We partnered with the Studer Group, which actually started by Quinn Studer, when he was a CEO in Florida. And the Studer Group is now owned by Huron, actually, but they partnered with a lot of the big hospitals, right? And so it's really just kind of organizational practices applied to the healthcare industry. And it's all about how do you make your managers more successful? How do you retain your employees, recognize them, hold them accountable, those types of things. So we have had those in place. And so one of the key things that our managers do is rounding. They round with the staff at least once a month. They're doing that more frequently. I think for retention, it's important to communicate to everyone. You know, number one, we really appreciate the fact that you're all working really hard and you're short staffed and recognize them and make sure the providers are engaging them you know, personally, and the managers are engaging them. We try to understand if there's issues we need to know about it. And we're just doing the best we can. I mean, you know, we're just doing that just much more proactively now, you know, and I think communication engagement is really important. And, you know, just the fact that all pretty much every other medical practice is going through this doesn't make it easier, right? I mean, it's one of those things. But, you know, hiring's been tough. I mean, I've been really tough on the MA front. I mean, it's locally, it's impossible to hire a nurse. It's almost impossible. And so our ASCs are short staffed. It's really difficult. The hospitals are really struggling. But it's not easy, you know, to hire MAs. But I will say, you know, we're fully staffed in our scheduling and billing and call center department. I think the remote work has helped that, you know, because that has been much easier to staff. Okay, we do have another raised hand. So, Dr. Al-Madani, I have unmuted your line. Yeah, I listed the question actually in the question and answer. My question, do you have any experience doing auto scheduling? By patients or leaving messages by patient to be scheduled later on versus a remote scheduler who is working not in the location outside? Do you have any comparison of certain experience or you don't have it? Auto scheduling, can you clarify what you mean by that? I mean, they go to the portal and schedule themselves. So we do have online scheduling. And so we've had that for a while. So patients can schedule an appointment online. They can request an appointment, obviously, online too. But we do have online scheduling. We also have a product that it works digitally. So it's texting. So for cancellations, it's called Q-Doctor. It's now owned by Freesia. But if someone cancels, it'll send a text message out to five people that are a certain amount of time out. And they can kind of take that appointment with the tech, you know, by replying to a text message. So that's about a 30% success rate. So we have that kind of a digital kind of scheduling. And then we have an online schedule. Yeah, we also have online scheduling. But at the back end, still, we use manual work. Like, I mean, someone looks at it and manually puts in the schedule and make sure the things are all the, you know, eyes are dotted and all the other things are taken care of. OK, our next question is, what are some strategies that have been used to demonstrate appreciation to staff? So and if we could get both the physician perspective and the nursing perspective from Kim, I think that would be great. Sorry. No, no, go ahead. At our facility, we try to have weekly lunches, breakfast for the staff. We try to have staff meetings and have them engaged and tell us what we can do to help them throughout their day. I find that that always works. Communication is always very important. They like to be asked how to make the center run better. Their opinion is very important, and they'd like to have their input because they are the ones basically doing that job. So we always go to them and ask them for feedback. And it seems to work because if there's a little bit of a change that can be made to make their job a little easier, we welcome it. So. And from the physicians. So, yeah, yeah, you know, this is this this is a multifactorial thing. When we started having this problem that, you know, we could see the M.A.s and all the staff in the clinic is feels like you can you can feel that they are overburdened and, you know, you can you can feel those tremors going on around and slowly getting there. You have to communicate with them. That is the most important thing. You talk to them, see what the problems are. I mean, where they are feeling stressed out. I mean, see if you can share that or get some more people come in and share that burden. And that actually has worked with us. But we have done is, you know, many time our M.A.s who are working with the physicians, their biggest stress is that when they are taking the patient, sending their task, calling them for, you know, different issues or the physician sending them tasks to call the patient and tell them about different things. So we just shared that among on their parts and say, OK, you know what? You have to share this work. If one has less work, we need to be a collective team here. And that actually has worked really good for us. So basically, end of the day, it's the communication part. You talk to the M.A.s, you talk to the staff and they will open up. They'll tell you what the problems are. And that actually opens ways to solve those issues. And that has helped in our practice in that. Those are great ideas. I mean, I think and I'll just echo, I think just engagement and communication are really, really important, whatever way you can do it. So we've had myself and the physicians having huddles or meeting with the staff, especially when you have new staff. We used to have education meetings, but they're not interested in GERD. They're interested in, you know, how do I do this workflow? How do I do this? How do I do that? And so our message has been we have a lot of new M.A.s, for example, and we're leaning on the leading on the more experienced ones, which is hard for them. It's hard for the managers. You know, so it's really support and engagement. I've asked the providers to try and pick up some of the tasks that they might just dump on the M.A.'s plate. You know, how can we do this as a team? And I think, again, that's important. And telling just telling the staff, if you don't know how to do it, ask us because, you know, you may not. And that's OK. Right. And so, you know, just engagement, support. I had I've had when you have a lot of new employees, you don't know their names. And so we had to make sure our managers put name tags out. So and we encourage all the providers to talk if you talk to someone by name, it makes a huge difference. Right. And it becomes a little bit more personal. So all those things matter. Just the recognition that, you know, you need to do these things differently and be as personal as possible. You know, and managers really need a lot of support. So we meet with our managers on a much more frequent basis now, and they really appreciate that. I mean, they're stressed. Right. I mean, and especially if they're newer managers.

remote working

challenges

employee morale

monitoring performance

communication

staff motivation