Economic Considerations
When this crisis abates, who will be coming into our clinics? We may have the same clinic panel, but their insurance status may have changed. Some may be uninsured; some may be on Medicaid rather than commercial insurance.12 These numbers will depend on how deeply the economy contracts and how quickly it bounces back.
Do you accept Medicaid or self-pay patients? Do you have an up-to-date pay scale for self-pay patients that is fair to them and to you? If you haven’t previously accepted Medicaid patients, will this crisis change your view? There are no right or wrong answers; the mistake would be not to prepare.
Have you considered the potential burden on your pre-certification staff related to new drug prior authorizations for patients on new insurance?
If you offer health insurance, consider projections of up to a 40% increase in insurance premiums next year due to COVID-19-related costs.13 Although that’s a high-end projection, give some thought to budgeting healthcare costs.
What about volume? Due to pent-up demand, you may have a surge in patients. Do you have a staffing plan for providers and staff that may allow for increased access? Have you evaluated vacation schedules and considered adjusting them? Again, there are no right or wrong answers; it’s only wrong not to think about these possibilities. For many of us, an already long backlog of new-patient referrals will be only longer. Creative re-thinking of how we use extenders, when applicable, may be warranted and will likely play a larger role in the post-COVID-19 era.
Government Relief
Some private clinics may have applied for and obtained Small Business Association (SBA) forgivable loans. Most private clinics and larger employed groups received a share of $50 billion in HHS relief funds distributed in mid-April. The HHS funds must be used in response to COVID-19 pressures (e.g., loss of E/M and/or infusion revenue; information technology/telehealth costs related to COVID-19; staffing costs, such as staff kept on payroll who may have otherwise been furloughed, hazard and/or overtime pay, and/or training costs related to COVID-19; costs related to cleaning and personal protective equipment; fees paid to consultants, accountants or billing services related to your COVID-19 response).
If you received more than $150,000, you will need to provide an accounting each quarter of how these funds were spent. At least 75% of the SBA loan funds must be used for payroll-related expenses; the other 25% may be used for rent and utilities. Use of the funds for other purposes is not precluded, but the funds may need to be repaid at a 1% interest rate.14,15 Be sure not to double count any expenses toward both SBA and HHS funds.
