Ed Tucker, CPA, CMC, LSSBB

April 22, 2020


As I write this article on Wednesday, April 22, 2020, some areas of our country are suffering many cases and many deaths from COVID-19. Other areas have fewer cases and fewer deaths. The virus appears to be especially dangerous to the elderly, people with underlying health issues, and minorities.

There are real or perceived shortages and less than optimum distribution of masks, ventilators, personal protective equipment, and pharmaceuticals. Neither a vaccine nor a treatment exists right now. But health care has many heroes – people putting themselves in harm’s way for others every day.

The Governors and Mayors of our various states and cities have imposed various levels of social distancing, work from home, banning of gatherings and the like. There are “essential” versus “non- essential” businesses, jobs and activities – decided by elected officials, not employers or families. For some reason it is OK to go to the grocery store to buy fish, but not OK to sit socially isolated on a shore or in a boat and catch your own fish. I like to fish.

There are protests for Governors to “open up” the economy and opposing protests for things to stay closed for safety. The federal government has issued “Guidelines for Opening Up American Again,” with responsibility for action delegated largely to the States, following the Constitution.

In health care, clinics are shut down. Ambulatory surgery centers have shut down completely since nearly all their cases are “elective.” Hospitals are still mostly open, but impaired financially because profitable elective cases were ordered shut down while uncompensated care and low case volume continue. Expenses are up. Paradoxically during a pandemic, furloughs of employees are up. Health care organizations are currently operating either almost not at all or in “hero” mode, following their emergency management plans and FEMA guidelines.

How will we re-open? Will we just go back to “business as usual?” Or will people still shy away from each other? Today I went on an “essential” mission to Wal-Mart and saw a guy wearing a Veterans hat and a huge plastic bubble across his face. I tried to go about six feet away to thank him for having served, and he just waved me away. Many Vietnam veterans have never been thanked and the unseen virus enemy made that veteran hero shy away from being thanked. That is sad.

Here are some thoughts from my perspective as a healthcare-focused CPA and Certified Management Consultant on how health care organizations can transition back to normal, or as they say, the “new normal.”

Do not get stuck in the current or former status quo with bad feelings. Honor your stakeholders’ crisis experience and value their pre-crisis and crisis contributions Take the opportunity to build up your team by honoring their contributions in this enormous shared experience that has bonded you.

Communicate using “embrace, empathize and educate.” Your patients, staff, physicians, providers, suppliers and governing board have all been through varying experiences.

As you communicate, “embrace” their experiences and probe for lessons learned.

“Empathize” at all points by genuinely asking, “how are you” and “how can I help?”

Finally, “educate” all stakeholders on the organization’s strategic intent and how they can help.

Get part of your team working on getting back to normal. If everyone works in “hero” mode until things settle down, you will have a long re-start period. Get some key team members working now on the restart. For example, keep your revenue cycle people working down the receivables from prior services, so they have no backlog when service levels kick in. Perform deferred and preventive equipment and facility maintenance now while facilities are under-utilized. Super-clean your clinic facilities.

Get back to basics. Focus on survival, maintenance, and growth – in that order. You will not be able to jump from survival to growth in one step. Focus on sustainability then maintenance and profits will eventually follow. Once you decide your direction, anticipate the barriers and identify actions to eliminate or minimize the impact of barriers.

Require speed and focus to return to action.

Do not try implement 10 or 12 strategies all at once. Focus on three or four initiatives, get them working and then move to the next strategies.

Make each new idea an experiment of sorts. Do not wait for the perfect solution. Solicit new ideas and test them quickly by doing a rapid cycle test for one hour, one shift, one week. If the idea works, fully implement it; or keep the parts that did work and revamp what did not work.

Use “progressive automation” versus trying for the perfect solution all at once.

Do not make plans too detailed – but have frequent checkpoints. This approach will help you use sprints, micro-bursts of action and rapid cycle testing to be more agile.

Make patients feel safe. Here are a few ways.

Make sure it is visible to your patients that their areas are clean, shiny and regularly sanitized. Your housekeeping and other staff are your heroes here – make sure they are visible, valued and engaged. Put a tent card in each exam room showing the time the room was last cleaned and sanitized, which should have been from the previous patient. The card should even have a checked-off checklist of what was sanitized.

Provide separate entrances and waiting areas for “sick” patients and “well” patients.

Pediatricians do this all the time with separate well-baby and sick-baby entrances.

Make check-in safer and more convenient at the same time. Let patients check in to clinics or outpatient areas from their cars by phone or phone app and remain in their cars until called. If you make this approach an ongoing practice, you will need less waiting room space.

Ask patients take pictures of their IDs and Insurance Cards and email or text them to the desk – even from their homes in advance of appointment time. We want to get that information sooner anyway, don’t we, to verify insurance? And the patient, not the staff is doing the scanning work.

Make patients’ experience more convenient.

Be on time. Honor patients’ appointment times. Their time is even more valuable to them now because they may need to be at work financially even more than they did previously.

Use telemedicine to fill gaps in the schedule. In the past some busy clinics often slightly overbooked to ensure that providers stayed busy during available time. Now, with possibly fewer insured patients and patients needing to be at work, demand may slow down, leaving holes in the schedule. “Shape” demand by scheduling telemedicine visits during schedule gaps – stimulating demand and making it more convenient to the patient.

Extend your hours with telemedicine for patient convenience. Extending hours in the old model meant keeping all the staff at the facility on overtime. With telemedicine, the provider can be available without all the other staff having to be present.

Start your future scanning now. The future is likely to look much different from what you thought two months ago. You will need people throughout your organization – at least to front-line supervisors – doing future scanning for their areas of responsibility.

Create a spreadsheet matrix of responsibilities and require brief weekly updates. Provide a data vault on Dropbox, OneDrive or Google Docs to store articles and research materials.

Topics will cover such areas as telemedicine technology, telemedicine billing, changes in the local and national economy, local employment trends, insurance coverage trends, human resource availability and compensation trends, government assistance opportunities and requirements, payer requirement changes, and the list goes on.

Remember, sustainability then maintenance then growth.

G. Edward Tucker, Jr., CPA,
MBA Certified Management
Consultant Lean Six Sigma Black Belt

Helping clients achieve sustained business growth. ed@getucker.com