What business looks like post-COVID-19
Several U.S. states have begun to lift stay-at-home orders and resume elective medical procedures. When and how practices reopen is a complex decision that depends on many variables from region to region, however.
One thing that is clear is that there will be no such thing as going “back to normal.” So practices need to prepare early and thoroughly for what business will look like in our “new normal,” which will certainly include wearing protective masks, social distancing, and limiting the use of waiting rooms.
Here’s what several doctors around the country had to say about the changes they’re making in their practices.
Make a plan—and make sure it’s flexible.
In the April 8 episode of The Power Hour optometry radio show, host Dr. Gary Gerber discussed reopening strategies at a time when things are in flux and there are more questions than answers. The most important step is to develop a plan that encompasses the three groups that will be affected by post-COVID-19 changes: providers, staff, and patients, he said. Since no one knows exactly what to expect going forward, your plan will need to be fluid and flexible.
There are several essential elements your plan must include. Will you close your waiting room entirely, or place chairs six feet apart? Will patients have to come in by themselves, or will you allow companions if they are screened upon arrival as well? These are all things you’ll need to think through and plan for well in advance of reopening, and communicate the changes to your patients.
Reach out to patients early and often.
Speaking of patient communication, all of the doctors interviewed on The Power Hour reinforced that you should not be waiting for patients to call you when you reopen—you should be proactively communicating with them throughout this crisis. Let them know how to get supplies they might need, such as contact lenses, how to schedule a telemedicine consult if needed, and when you expect to reopen for routine and non-emergency care. Robert Davis, O.D., a practice owner in Florida, said, “Give them a date, even if you have to change it.”
Allow for social distancing.
Before you reopen, you will need to think through every little piece of the patient journey, Dr. Gerber advised, from the moment a patient enters your practice—Do they touch the handle? Is your door propped open?—to how they sign in—Can they check in online? Should they bring their own pen?—so on. “Every aspect of the patient journey from that starting point until they exit has to be thought through with regards to social distancing,” he noted.
Think through every aspect of the patient journey, from arrival to exit, as well as how your physical space and staffing needs will affect social distancing requirements.
Some aspects of your social distancing plan will be dictated by your physical space. It’s inevitable that in the short term at least, you will need to schedule fewer patients overall and build in extra time between appointments to avoid overlap and allow time for cleaning and disinfecting.
Reinforce the idea of what social distancing is, and isn’t, by sharing our new Rendia video with your patients.
Control traffic flow.
If your office layout allows for it, you might consider what some grocery stores have done and implement one-way traffic throughout your practice, suggested Dr. Gerber. You might also borrow the idea of designating early morning hours for your older patients, knowing they may require more time and be accompanied by caregivers.
Adjust scheduling and staffing.
Dr. Davis said on the April 29 episode of The Power Hour that after four weeks of being closed, his practice has recently reopened with just two doctors instead of the previous six. They have extended their hours but split the day into two shifts, with two dispensing opticians in the morning and two in the afternoon, as opposed to their pre-COVID six opticians. Now, they see one patient every 30 minutes instead of every 15 minutes.
In some states, rules governing how many people can gather in one location will dictate your scheduling. David Holler, O.D., a practice owner in North Carolina, said “We’re under state guidelines of having 10 people or less in a location at one time, so I have to limit the number of staff I have” as well as consider how to schedule patients so they won’t overlap.
Train staff on your new procedures.
Whether your previous staff is returning from furlough or you’ve had to hire new employees, it’s important to dedicate time to training staff on your new procedures and to recognize that training must be ongoing as situations continue to change.
Dr. Davis made the decision to test all his employees for COVID-19 prior to their return to work; one tested positive. Patients arriving at the office will have their temperature taken.
“We’re even thinking about using an oximeter to check their oxygen levels,” said Dr. Davis. “A lot of ophthalmologists and optometrists are doing that. That might be a better test than taking their temperature. And if they have a saturation level below 90, we might not want to see them. We might advise that they go and get tested.”
Pre-screen patients outdoors if possible.
Dr. Holler’s practice has set up a canopy outside to do pre-screening and take patients’ temperatures before they enter the office. While he plans to reopen with the practice’s normal hours of 9 a.m. – 6 p.m. six days a week, he will reevaluate based on patient demand.
Rethink your waiting room.
For many practices, the goal post-COVID-19 is to eliminate the waiting room entirely, while other practices are redesigning theirs to allow for social distancing. Some practices are asking patients to notify the front desk upon their arrival in the parking lot and wait in the car until their appointment. Share videos, like this one and this one to explain the changes to patients in advance. Also consider what patient education videos you can send them to watch in the car while they wait. Be sure to share your practice’s guest WiFi login along with the videos.
PPE is a big part of any practice reopening plan. What will staff wear? How will it be disposed of? Are patients required to wear masks? And what if they refuse?
Plan for PPE.
A major consideration for any practice reopening plan is PPE—what do you have, how will it be worn, and how will it be disposed of? Will you supply masks and/or gloves to patients, or require them to bring their own? If you supply PPE, will you charge patients a fee?
Dr. Holler said they are letting patients know—via email, text, and Facebook posts—that the staff is wearing masks and is expecting patients to do the same. “We have had some patients refuse,” he noted. This is where it’s helpful to check your state or county guidelines about face mask requirements.
In our next post, we’ll share additional tips for things to think about and implement once your doors are open and you’re seeing patients again. Everything from how you clean your office to how you communicate with patients in the exam room has changed, post-COVID-19. We want to make sure you’re set up for success.