Applying the biggest lessons of COVID-19 to medical practice challenges in 2021

As we reflect on 2020, there are numerous lessons learned during the COVID-19 pandemic that healthcare leaders need to carry with them to face the challenges looming in 2021.

A Dec. 15 expert panel webinar, “Learning From 2020 to Thrive in 2021,” outlined those lessons and challenges, with insights from:

• Brian Ramos, MBA, CMPE, chief operating officer, Capital Anesthesia Partners
• Cameron Cox III, MHA, FACMPE, president and CEO, MSOC Health
• Maddox Casey, CPA, member, Warren Averett
• Nelson Gomes, senior vice president of development, Medicus IT
• Nan Gallagher, JD, principal, The Nan Gallagher Law Group
• Wiks Moffat, principal and executive vice president, Healthcare Compliance Network LLC.

The biggest lessons of 2020

Most of the panel agreed that 2020 and the COVID-19 pandemic exposed numerous areas of practice management and performance to a harsh reality of newfound assessment and evaluation. “We’re not as good as we thought we were” in some areas, Casey said, “and we’re better than we thought” in others.

Gomes and Moffat each noted that the role of policies and procedures was highlighted, and that responding to the pandemic shows that simply having an action plan is not enough — testing it is the true measure of success. “The last nine months have shown that [practices] really need to do that,” Moffat said.

“The entire way of seeing patients has changed,” Gomes said, referring to the ways practices revamped physical spaces or shifted patients to waiting in their cars rather than a front office. Gallagher echoed that by suggesting that practice leaders should not be afraid of change or reinvention, in terms of personal leadership and as an employer.

More specifically, Ramos reminded how the first rule of business school became clear for most medical groups: “Cash is king.” Practices that kept good control on cash reserves and worked quickly to shore up capital during the early months of the pandemic will be most likely to weather the early months of 2021.

Trends in patient-owed balances and collections in 2021

Most of the panel agreed that increasing A/R balances are a big threat, through a mix of patients facing economic downturn and a willingness of organizations to relax collection policies in recognition of the financial hardships faced by patients who have lost jobs and/or coverage.

With lots of forbearance for evictions and many thousands of Americans behind on rent, “we’re in for a long economic recovery” in 2021, Ramos noted. Ramos suggested reviewing your self-pay and payment plan policies “to make sure they’re really relevant for the economic environment that patients are in today” before handing debts off to collection.

Cox noted that more practices need to take a closer look at credit card on file (CCoF) policies, contactless pay options and implementation of eligibility-check tools, as well as looking into patient communication platforms that integrate with your practice management system (PMS).

Making it easier for patients to access payment platforms should be a priority, Cox added, noting that existing patient portals often are configured more for the providers than the patients. “You’re seeing the rest of the world adapt,” Cox said, noting the improvements some retail pharmacies have made with CCoF. “With the pandemic, it’s requiring us to push” for more digital solutions to facilitate payments.

Gallagher said she has seen some practices implement alternative payment options such as Venmo, but cautioned that it’s important to make sure payment settings are set to private.

Multiple panelists encouraged practice leaders to take a closer look at their front desk staff, as many of those positions suffer from high turnover, lower pay and little education on collections, Casey said. “I encourage everyone [to] invest in that position — a little more salary and training,” Gallagher said, can go a long way to boost collections and improve patient satisfaction.

Telehealth trends in 2021

There was less uniformity of responses when the panel was asked about what to expect with telehealth. Moffat — wary of the potential end to regulatory waivers and reimbursement changes that enabled the rapid expansion of virtual care in 2020 — cautioned that “the party’s going to be over soon,” and that practices should be prepared to ensure all their systems are pre-pandemic HIPAA compliant.

However, Cox signaled that he doesn’t see telemedicine being curtailed significantly, especially as many patients continue working from home. Even if there are lingering generational differences in which patients prefer virtual visits, Cox stressed that your population needs to know what’s available so they can seek out the services: “Market this to death.” Gallagher noted that many patients now prefer a virtual visit because they report getting better eye contact with the provider versus an in-person visit.

Gomes said that practices are likely to seek out more integrations between telehealth platforms and an EHR to simplify charting. “Efficiency is going to be a big thing,” Gomes added. However, it remains important to ensure physicians and staff are trained for effective virtual visits, Gomes said, and that practice leaders should not overlook the user experience when evaluating telehealth performance.

• Learn more about Medicare telehealth reimbursement in 2021 in an MGMA analysis of the Medicare Physician Fee Schedule final rule and quality reporting changes.

Compliance issues in 2021

Moffat said that compliance programs need careful attention, especially as the federal government steps up enforcement activities and fines. Additionally, Moffat said that practice leaders ought not neglect OSHA compliance. “They don’t fine a lot,” but the enforcement actions that come along with being sued, such as demonstration of your compliance program and efforts taken, care be very costly in terms of time and effort.

To know where to step up your efforts, Ramos suggested reviewing the U.S. Department of Health & Human Services (HHS) Office of Inspector General (OIG) work plan, which details what the OIG anticipates investigating. “It’s the best place to catch items that are not top of mind for your practice” that could prove problematic in 2021, Ramos said.

Remote work in 2021

Most of the panel saw the shift toward remote work to become “a permanent shift,” as Cox said, noting that many other industries have moved toward allowing remote work in perpetuity. Cox and Gallagher said this means practice leaders will need to think about physical space needs before signing future leases.

Gomes said this means practice administrative leaders must stay on top of security and compliance best practices for those remote workers, and to ensure those employees don’t experience connectivity issues as more members of the household use bandwidth for school, gaming, streaming and other recreational activities.

The best thing to do, Ramos said, is treat the shift toward remote work as an opportunity to “re-envision what a medical practice” can and should be. Instead of filling open positions as you did before the pandemic, it might make the most sense to specifically recruit people who thrive by working at home.