Reopening Your Medical Practice During COVID-19

Updated on June 25, 2020 & Sept 10, 2020.

Reopening a medical practice during the COVID-19 pandemic requires physicians, their staff, and their patients to cooperate, to adapt, and to be flexible and responsive to changes. This article describes practical steps for reopening your medical practice during COVID-19. Changing conditions need to be kept in mind at all times.

Considerations Before Reopening

Consult Your Local Public Health Department

The conditions and requirements for reopening a medical practice vary within the state, counties, and even cities and will change over time. We recommend you to consult your local public health department prior to reopening your medical practice. Be aware of changing conditions. When stay-at-home orders are being lifted, this does not mean they cannot be reinstated.

Here is a list of the public health departments of the counties in the San Francisco Bay Area:

• Alameda County Public Health
• Contra Costa Health Services
• Marin Health & Human Services
• Napa County Public Health
• San Francisco Department of Public Health
• San Mateo County Health
• Santa Clara County Public Health
• Solano County Public Health
• Sonoma County Public Health

Update Your Operations Plan

Before reopening your practice, update your financial and staffing plan. This includes anticipated patient volume, changes in hours, and the use of telehealth. Work with your staff and ask for their flexibility to adjust for changes in patient volume and working hours. Always be aware of changing conditions.

Flexibility is the key to stability.

John Wooden

Revise Your Safety Protocols

Review your existing safety protocols and make adjustments for increased safety to protection against COVID-19. Communicate and train your staff on the updated safety protocols.

Assess Supply of Personal Protective Equipment

Review the guidelines from the Center for Disease Control and Prevention (CDC) and the California Department of Public Health (CDPH) guidelines on the use of Personal Protective Equipment (PPE).

List your current supply on hand and your potential supply needs. Plan your consumption of PPE by taking into consideration any supply chain limitations (order quantity limitations, longer delivery lead-times), and potential future surges. Follow these Strategies to Optimize the Supply of PPE and Equipment.

Communicate With Patients & Staff

The single biggest problem in communication is the illusion that it has taken place.

George Bernard Shaw

Throughout the process of reopening your practices, provide ongoing and clear guidance to patients and staff. Keep them informed about changes to your practice because of COVID-19 including increased safety protocols, extended hours, and the use of telehealth. In addition, provide them with ongoing guidance from public health sources on the known risks, testing, and treatment for COVID-19.

Other Factors Impacting Your Patients

Your patients may not have access to the same resources or medications during COVID-19. Some of your patients may be going financial hardship due to a lost job. Medication may be in shortage during the COVID-19 pandemic. Take these external factors into consideration and create alternative and backup plans for patient care.

Financial Management

As practices reopen, revenue and patient volume may increase slowly and unevenly. Keep in mind that many patients may be concerned about visiting a medical practice during the COVID-19 pandemic.  

Make sure your practice stays financially healthy while patient numbers may increase slowly, and do the following:

• List your capital needs and available funding sources, and create a budget. How much money will you need in each of the coming months? Will your cash flow be sufficient to keep your business afloat? The Small Business Administration (SBA) provides Small Business Guidance & Loan Resources during COVID-19. In addition, providers can benefit from the CARES Act Provider Relief Fund.
• Review your accounts receivable and communicate with your debtors. Work with them on a payment plan in case they cannot pay the total amount they owe you right now. Remember, getting paid over an agreed period of time is always better than not getting paid at all. Also, consider using an Accounts Receivable Recovery & Collections Service.
• Implement telehealth as an additional revenue stream generator with minimal extra cost (a virtual exam room).
• Review your payment methods for patients. Add a patient payment portal to your website.
• Evaluate accounts payable and create a plan to meet your existing obligations. Prepare a monthly budget to make sure you will meet your obligations in the months ahead.
• Reach out to your vendors to negotiate deferrals or alternative payment plans. A few weeks of financial deferral can make a huge difference in your practice’s financial wellbeing.
• Update patient contact & insurance information whenever changes occur. You do not want to waste time submitting medical bills based on wrong insurance information, as it will quickly deteriorate your financial position in these uncertain times.
• Ensure your coding and billing staff receive education on new and updated rules under COVID-19.
• Consider outsourcing your coding, your billing or other services as needed.
• Minimize your fixed cost. Talk to your landlord about rent relief options (rent reduction, rent deferral, rent abatement, or flexible payment options).

Human Resources Management

As practices adapt to changing patient volume and the increasing use of telehealth, you should:

• Adjust your physician & staff workforce in a form that is responsive to changing conditions.
• Assess when to have furloughed staff return, based on your reopening schedule and patient volume.
• Consider the layoffs of unnecessary personnel and the outsourcing of certain office functions.
• Give extra attention to the emotional and physical needs of your staff.
• Consider alternatives for vulnerable staff.
• Consider implementing a temperature check-in policy for returning personnel, and clearly communicate new policies in advance.
• Increase the physical spacing between workstations to promote better distancing. Gain additional office space by replacing the physical document archive with a web-based document management system.

Office Safety

Maintain Physical Distancing

• Reopening your medical practice during COVID-19 is not a one-day event. Instead, you will need to reopen incrementally. Use a calendar to chart out a reopening day and the first week when you begin with a few in-person visits per day. Gradually increase that visit number, and consider the time you spend on seeing patients remotely. Communicate your weekly to your patients, your physicians, and your staff.
• Implement a remote check-in. Have your patients check in by phone and wait in their car until you are ready to see them.
• Schedule patients such that only a few are in the office at any given time.
• Avoid guests & visitors, and arrange foot traffic to minimize interactions.
• Limit the number of patients in the office, and set aside hours for vulnerable patients (elderly, immunocompromised, etc.). Consider seeing patients with acute illnesses on specific days or at specific times (late in the day is best).
• Preferably have patients enter and leave your practice through separate doors.
• Remind your patients of the importance of physical distancing to stop the spread of germs.

The CDC offers leaflets in several languages:

• Stop the Spread of Germs (English)
• Detenga la propagación de gérmenes (Spanish)
• Ngăn Chặn Sự Lây Lan của Mầm Bệnh (Vietnamese)
• 阻止细菌传播 (Chinese)
• Itigil ang Pagkalat ng Mikrobyo (Tagalog)
• 병원균 확산 방지 (Korean)

Require Patients & Staff to Wear Face Masks

Protecting your patients and your staff requires that all of them wear a face mask. Provide your patients advice on the effective use of a face mask: How to wear a non-medical fabric mask safely

Implement Strict Sterilization Procedures

See the CDC Guidelines for Disinfection and Sterilization in Healthcare Facilities.

Use Telehealth As Appropriate

Telehealth describes the use of 2-way communication technology for certain health care services. During the COVID-19 health emergency, the Department of Health & Human Services (HHS) has taken steps to make it easier to provide telehealth services. The HHS encourages health care providers to adopt and use telehealth as a way to safely provide care to patients in appropriate situations. Those situations include routine health care (like wellness visits), medication consultation, dermatology (skincare), eye exams, nutrition counseling, and mental health counseling.

The HHS Office for Civil Rights (OCR) has issued guidance to empower health care providers to serve patients through telehealth during the national public health emergency.

HIPAA-covered health care providers may provide telehealth services to patients using remote communication technologies. During the COVID-19 pandemic, providers are even allowed to use apps like FaceTime, Facebook Messenger, Google Meet, Zoom, or Skype for telehealth services. Not all of those applications comply with HIPAA rules. Remember, this exception is COVID-19 specific and only temporary!

Pre-screen Patients Over Phone

Prior to an office appointment, pre-screen patients for possible COVID-19 symptoms. This reduces the risk of having potentially infected patients visit your practice.

Here is a leaflet from the CDC you can share with your patients: Symptoms of COVID-19.

Use Personal Protective Equipment Appropriately

Follow the CDC Guideline: Using Personal Protective Equipment (PPE)

Establish A Quarantine Policy

Follow the CDC Guidance on Quarantine and Isolation

Put Safety First

With the uncertainty around the virus, patients are grateful for practices that prioritize safety. Be sure to let them know what you are doing to protect them and your staff. Finally, remember that reopening your medical practice during COVID-19 will take some time, and will require flexibility and cooperation from all parties involved. Frequently communicate to make sure everyone knows what is going to happen and has time to adjust to this new setting.

Additional Resources

Centers for Disease Control and Prevention (CDC): Coronavirus (COVID-19) Guidelines

Department of Health & Human Services (HHS): Coronavirus (COVID-19)

California Department of Public Health (CDPH): COVID-19 Updates

California Department of Public Health (CDPH): Resuming California’s Deferred and Preventive Health Care

Health Officers Association of California: Reference Materials

California Medical Association (CMA): COVID-19 Resources

American Medical Association (AMA): COVID-19: A Physician Guide to Reopening

Medical Group Management Association (MGMA): COVID-19 Medical Practice Reopening Checklist

Small Business Administration (SBA): Coronavirus (COVID-19): Small Business Guidance & Loan Resources

Department of Health & Human Services (HHS): CARES Act Provider Relief Fund