From the Editors of Review of Ophthalmology:

Staying Viable During a Shutdown

Elizabeth Monroe, a partner and senior consultant at BSM Consulting Group in Phoenix, Arizona, notes that when it comes to managing a shutdown during a pandemic, every practice situation is somewhat different. “I have ophthalmology clients who haven’t completely shut down because they have subspecialties in their practices that still need to see patients, such as retinal physicians who need to provide anti-VEGF injections,” she notes. “At the same time, we have clients who are already preparing to reopen.”
BSM Consulting offers a number of free resources at their website (, including a detailed checklist for shutting down your practice during the pandemic that anyone can access for free. (The checklist is formatted in Excel, so that you can alter the content to match your specific situation and needs.)
Ms. Monroe says there are a couple of key issues to keep in mind when partially or completely shutting down your practice during the pandemic—assuming, of course, that your intention is to resume operations after the crisis has peaked or been resolved. “Any practice in this situation needs to focus on some primary tenets,” she says. “Those include patient and staff safety, and making sure the practice remains viable during the break so that resuming operations later will be possible.”
According to Ms. Monroe, key issues to focus on include:
• Communicate with your patients. “Contact all of your patients and keep them apprised of what you’re doing,” she says. “Of course, you have to contact them if you’re rescheduling an appointment, but in any case you should stay in touch with them throughout the closed period.”
• Stay in touch with your staff. “If employees are furloughed, be sure to have at least a weekly meeting with them,” she suggests. “Share updates. Describe what’s happening in the clinic and talk about when the practice might reopen and they might be recalled. It’s easy to become depressed in this situation, and your contact will help them stay positive.”
• Make sure your practice website stays up-to-date. “This is an important way to communicate with your patients,” she notes. “You can let them know what’s happening and what to expect regarding practical matters such as scheduling appointments. You should also give patients a way to contact the practice, whether it’s through the social media page, the website or via a phone number.”
• Keep track of the status of all patients. “Make sure that everyone managing patient status shares a comprehensive database,” says Ms. Monroe. “You need to know who’s cancelled an appointment, who’s been rescheduled, and who may need surgery, among other things. These lists will be particularly important once it’s time to start reopening.”
• Make sure your building and facilities are secure. “You don’t want people going in and out who shouldn’t have access during this time period,” she notes. “You may have to put access to the building on hold.”
• Stop unnecessary building services to preserve cash. “You don’t need the same level of cleaning during this period, for example,” she points out.
• Make sure you have adequate signage about the shutdown placed outside your building. “Patients may have missed your communications about the shutdown,” Ms. Monroe points out. “Some patients may drive by and decide to stop, or simply come to your office not realizing their appointment has been postponed. Make sure that the signage explains how to contact you.”
• Be sure you understand the conditions to get PPP loan forgiveness. “The CARES act passed by Congress has a loan forgiveness portion that revolves around practices bringing their staff members back,” she notes. “That may be possible to activate even while the practice is partially shuttered. Make sure you don’t miss opportunities to bring capital back into the business. Also, if your practice has applied for or received a PPP loan through the CARES act, stay tuned on additional details regarding this program. We continually receive updated guidelines related to availability of funds and loan forgiveness calculations.”
• Be prepared to extend grace to some of your staff when you ask them to return. “In some cases, practices have tried to call back staff and the staff haven’t been able or willing to come back right away,” says Ms. Monroe. “They may be caring for an elderly parent and thought they’d be off longer, so now they need to reframe that care situation. Or they have kids at home being home-schooled. In addition, some staff may refuse to come back because they don’t feel safe; as long as there’s a risk of contracting COVID-19, that could be a factor. And in some cases, low-paid employees may also be getting more income on the temporarily expanded unemployment benefits than they make working in your practice. “The point is,” she concludes, “you may need to extend some grace to your staff when you ask them to return, for a variety of reasons.”
• Use the downtime to reevaluate and reinvent your practice. Ms. Monroe notes that this can be done on several fronts. “In the past few years, many practices have developed technologies that allow them to stay in touch with patients, such as a patient portal,” she says. “If you haven’t done that yet, this may be an excellent opportunity to research vendors and find technological solutions you can implement in the future.
“Right-sizing your practice is important too,” she continues. “Perhaps you haven’t being using the best staffing model. This could be a good opportunity to look at that. Let’s say you have a provider who is commission-only but hasn’t been producing. Should you keep that person on staff? Or perhaps you have multiple locations, and some haven’t been doing that well. You can consider consolidating and moving to a leaner business model.
“This is a good opportunity to look at the organization from top to bottom,” she concludes. “Make sure you’re running your practice in its best form. And make sure your existing model will still be relevant post-COVID-19.”



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