1. All Massachusetts groups indicated that, due to the cancellation of all elective surgeries, they are likely running only 2-3 anesthetizing locations (in most cases, an 80% reduction). RI clients said that no elective cancellations have yet taken place, but they are currently under discussion.
2. In terms of preserving cash flow in your practices, consider the following:
a. File an extension for the 2019 tax return; delay funding any remaining 2019 corporate retirement plan contribution, if those contributions haven’t yet been made.
b. Do not fund 2020 corporate retirement for now; employees can consider stopping their 401k contributions if they need the cash flow
c. Do not issue any bonuses
d. Request shareholders to delay seeking reimbursement for professional expenses
e. Delay payment of other discretionary spending, if any
f. If individual employees are concerned about their personal cash flow, they should consider seeking a personal line of credit. Corporations can also think about corporate loans and lines of credit, either from a bank (which could be tedious and time consuming), from shareholders, or ideally through the Government, to fund some level of salary support during the crisis. Corporate borrowing presents a variety of issues that will require discussion with your accountant and HMA consultant.
g. Work with your billing companies to ensure that you are meeting the requirements and billing for any telemedicine, critical care and ventilator management services
3. There has been some discussion of a new potential source of revenue entitled “Covid Pay”. Anesthesiologists in certain institutions have mentioned that their Hospital administration suggests that they create and maintain a log of hours that each of the group’s employees spend related to the crisis. Although we don’t currently understand what this means, and how doing so will result in compensation, HMA suggests that you and your colleagues immediately begin to log hours and description of services that are being provided during those hours. Some examples of Covid hours include: Taking care of patients with Covid or suspected; Intubations (total time); Training and reading protocols; and Assisting in Covid related care.
4. Each practice needs to assess its staffing needs due to the decrease in coverage requirements. The initial round of this assessment will likely be related only to the new level of staffing required to meet the OR/Endo (if any), OB and on-call obligations and not the issues listed in #6 below.
5. Perhaps the most important potential source of ongoing revenue:
Each practice should be meeting with their Hospital administration to determine how they can be helpful to care for the projected influx of patients that will need care. Anesthesiologists and some CRNAs are in a good position to supplement the Emergency and ICU MD and ancillary staff. GROUPS SHOULD DISCUSS WITH HOSPITAL ADMINISTRATION the following:
- THEIR SKILL SETS and HOW MANY MD AND CRNA RESOURCES THEY HAVE AVAILABLE (after considering their primary needs for coverage, allowing for some unpredictable level of staff that may be sick or quarantined, and determining who is willing or unwilling to act as an intensivist);
- HOW TO INTEGRATE THAT STAFF INTO THE EMERGENCY COVERAGE PLAN AT THE HOSPITAL; AND
- HOW THE GROUP WILL BE PAID BY THE HOSPITAL FOR LEASING THESE GROUP EMPLOYEES TO THE HOSPITAL.
GROUP LEADERS SHOULD BE THINKING OF HAVING THIS CONVERSATION VERY SOON. Please work with your HMA consultant to discuss a strategy for this meeting with administration. IT WILL BE IMPORTANT FOR YOU AND YOUR GROUP TO BE VIEWED BY ADMINISTRATION AS TEAM PLAYERS, NOT OPPORTUNISTS, IN ORDER TO PROTECT YOUR LONG-TERM RELATIONSHIP WITH THE HOSPITAL.
6. Once a group has exhausted all sources of new revenue and expense reductions and determines the level of staffing that will be required based on numbers 5 and 6 above, assuming that you still have excess staffing and related expenses, the group needs to seek volunteer employees who are willing to take unpaid time off, reductions in FTE work status and/or other ways to reduce staffing costs (e.g. Across the board pay cuts).
7. Since HMA clearly doesn’t provide legal advice, each group should speak with their attorney and review what obligations it has in its employment and independent contractor agreements (in terms of guaranteed hours, etc.) and address those issues accordingly. For example, are you required to provide any notice to contracted employees/contractors of reduced hours or reduced compensation?
8. From a business perspective, it is very important that group leaders communicate in a consistent manner with your employees. Groups should strive to continue to pay for benefits, such as health insurance. REMEMBER, at some point, hopefully in the not too distant future, the crisis will be significantly reduced, and you will need all of your employees to handle the backlogged volume of new cases that will occur. Treating all of your employees with honesty, respect and compassion during this crisis will go a long way towards employee loyalty in the future.
As you know, this situation is extremely fluid. HMA will strive to keep you informed of any ideas that we think can be helpful to manage your practice.