Coronavirus considerations for private practices

March 13, 2020

The pandemic will ultimately unveil shortcomings in our organizations and highlight opportunities for improvement.

COVID-19 has only just started to impact physician practices across this country. We can expect that in the weeks ahead, physicians will not only be on the frontline of treating patients, but many will also face potential struggles to keep their practices staffed and solvent. From a business perspective there are many issues for practices to consider:

1. Make sure that your practice is up to date on the status of the COVID-19 and the impact on your community of patients. Information is changing swiftly and daily updates among practice staff should be required to make sure protocols are up to date and in line with CDC and state guidance. Misinformation creates risk for all. Clearly communicate your practice’s policies to patients to avoid confusion and to keep staff and other patients safe. For example, patients have complained about being told to come to a practice’s office only to be rejected upon arrival. This needs to be strictly avoided. Practices should also use all means to communicate with patients such as social media, the practice website and the practice portal. One outcome of the practice’s poor handling of the current crisis is potential impact on its reputation and patient confidence.

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2. Most physician practices have policies and procedures when it comes to illness and disability. Make sure you understand your own policies and try to remain flexible. Employees that are ill should not be coming into work for fear of not being paid and sick employees should be sent home immediately until they are well. Many physicians are panicked at the idea of being short-staffed or otherwise not being able to open their practice to the public, and this is a real possibility. As an employer, the practice needs to play a role in helping to minimize spread of the virus. Telemedicine may be an option for some practices under the Coronavirus Preparedness and Response Supplemental Appropriations Act, which has relaxed the restrictions on physicians being able to offer telemedicine. You can read more here: https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf. Some practices are also bringing patient care to the homes of sick patients by offering in-home care, diagnostic testing, physical therapy and other services.

3. Unfortunately, many physician practices will be impacted financially by the coronavirus. Some loss may be due to sick patients who cannot pay for care (or free care that is offered to help with the pandemic), or the cost of covering overtime and sick pay for employees. Other practices who handle more elective procedures and services may face empty offices and minimal patient load, especially if communities are shut down. Hopefully state and federal governments will offer solutions in the weeks ahead.

4. It is important to remember that all the same rules that apply to the practice of medicine continue to apply. 

. Physicians must continue to meet their call and other contractual obligations, as long as they are well, and to satisfy the standards of the profession in terms of treating patients with respect and without discrimination. I have had calls from clients wanting to get out of call/coverage responsibilities because they fear becoming ill and the impact it might have on family members who are at risk. Unless alternative coverage can be arranged or the parties involved agree to a revision in duties, there are no legal exceptions. Safety precautions should be taken and physicians can consider alternative living arrangements to reduce risk. The consequences of non-compliance with a contract/medical staff bylaws can be significant.

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5. It is very possible that senior physicians in particular may be impacted medically by COVID-19, whether by severe illness or death. Make sure that your practice has some type of succession plan in place and contact counsel if you do not. It is never too late to plan ahead, and practice ownership and financial issues should be formally documented if possible. At a minimum, put a strategy in place among practice providers and management to protect the business and its employees should a tragedy occur.        

6. The current pandemic will come to an end over the next several weeks or months and hopefully we will have a quick return to normalcy. These unprecedented events will also help us all realize where we have shortcomings in our organizations and room for improvement. I am currently already working on altering our client’s contracts to address issues of future pandemics or similar events and how they will be handled in terms of termination sick leave, overtime pay and similar issues. If your practice has discovered your contracts or policies did not address the current crisis adequately, talk to counsel about changes your organization might need.

Ericka L. Adler, JD, LLM has practiced in the area of regulatory and transactional healthcare law for more than 20 years. She represents physicians and other healthcare providers across the country in their day-to-day legal needs, including contract negotiations, sale transactions, and complex joint ventures. She also works with providers on a wide variety of compliance issues such as Stark Law, Anti-Kickback Statute, and HIPAA. Ericka has been writing for Physicians Practice since 2011.