COVID-19 has affected us all negative in many ways. For this post I would like to take a step back and talk about the financial implications on my practice. In the post COVID-19 shut down, we have seen a huge drop in patient visits and income. We are not alone. It appears that many practices or groups nationwide are cutting salaries, having layoffs, or cutting back hours. I initially started writing this post in March 2020 and decided to post it now after some of the dust has settled. Featured image is Duke out on my family farm ready to go put corn in our feeders.
My practice was continuing to grow at about 15% month over month. I topped out around 135 patient encounters per week and my employee was almost equally as busy. I had my third doctor ready to start around May 2020 and was already getting a waiting list together for patients wanting to see them.
We also are set to move into our new clinic June 2020
Soon we will almost 5x our current space. I will 100% own the space we practice out of and will also now have our own lab.
Lock Down March 2020 Due To COVID-19
Around the second week of March, Texas had a form of lock down put into place. We quickly transitioned to telemedicine visits but found that income and visits that first week were down about 70%.
The first week was a shock. No one wanted to come in and our older population struggled a bit with telemed. Stories in my text message group were fill with doctors sent home without pay and threats of paychecks to be slashed. The slow down seemed to last about 3 weeks until we finally started to see a trend up.
As of the end of April, visits are now down about 20% from pre-covid-19 levels.
COVD-19 Outbreak In The Office
Two weeks after we went into lock down mode, COVID-19 broke out in our office. We had not physically had a patient in our office in over 14 days so you can imagine my confusion.
The only person who was swabbing patients was one MA (they swabbed only about 5 people and I swabbed the rest). The same MA who was swabbing patients was now sick. Immediately I couldn’t help but wonder if maybe some of those tests we preformed were false negatives. However, she later would go on to tell me they had a family member come stay with them who was recently ill but thought to be recovered.
Every patient that the MA swabbed came back negative for COVID-19. I ended up swabbing about 35 positive COVID-19 cases in the first 2 weeks.
My first employee who got sick would eventually go one to have flu-like symptoms for 10 days with loss of smell and taste. She has since made a full recovery but it took 5 weeks for her to have 2 negative COVID-19 swabs.
Second Employee Illness
About 2.5 weeks after my first employee was sick, another one of my employees (who is in their 20’s) showed up one day with a cough, runny nose, and itchy eyes. They thought it was just allergies. They told me they forget to take their Zyrtec so they figured that was probably the cause.
I was not taking any chances, swabbed her, then sent her home. Within 48 hours we heard she was also positive. Her symptoms would go on to be so severe that she had a brief stay in the hospital on supplemental O2 but never intubated. Luckily, she has since made a full recovery.
I would later find out that 4 days before getting sick, she broke the lock down rules. She attended a friends 21st birthday party who drove back from Los Angeles to stay with their parents. We assume this is where she contracted the virus. After all, it has now been about a month since we have had a single patient in the office.
Once she was positive I decided to swab my entire small office. Interestingly 2 of my employees with no symptoms were positive and my biller who had been working from home for the past 4 weeks was also positive!
Two More Illnesses
The 3 new employees who were positive ended up doing fine. Two had no symptoms at all while another one had about 36 hours of a migraine that was relieved with Tylenol. That was their only symptom.
On a side note, I find this virus very interesting. We went on to swab the families of the people who live with my employees and 1 out of 18 people living in these households in total returned positive. The rest remained negative. In fact, one of my employees continued to have their young kid and husband sleep in the same bed (she wore a mask at night) and they all remained negative via swabs. I also thought it was interesting that I swabbed myself and also remained negative despite swabbing all of the positive cases. Here we have a virus that put my youngest employee in the hospital with no health issues, some of my employees had no symptoms, and families living with these cases did not end up swabbing positive except one person.
Even though my employees get 2 weeks paid days off, I financially covered their paychecks while out sick. This includes the one employee who was out for 5 weeks.
Firing An Employee
As I described above, I had my biller working from home even before the lock down went into effect. I even told my employees that if they got COVID-19 that they would get at least 2 weeks paid off. The day after this email went out one employee stopped showing up and told another employee to tell me she was sick.
This employee ghosted me for a whole week, then one Saturday confirmed they would be back on Monday. This whole time they refused to come in and get tested for COVID-19. When I heard back from this employee the story changed to their phone was messed up and apologized that they didn’t reach out to me. Monday came and this employee claimed all 4 of their tires were slashed and she would be out of work for another 2 days. I also found out that on this same Monday, she went into the company email and wrote an unprofessional email to a patient that was very rude and demeaning.
That same monday I terminated her. Looking back should have done so earlier. I was attempting to give her the benefit of the doubt in light of COVID 19 but true colors shined through.
Furloughs and the Paycheck Protection Act
With business being down about 70% at its peak, things were financially not looking good.
I was now paying for most of my employees to sit at home and recover from COVID-19. Meanwhile, insurance payments were drying up. Times were tense. I was not sleeping well.
The paycheck protection act was announced and I applied day one it was available. Despite banking with Wells Fargo for 18 years, they claimed to run out of money before my application was reviewed.
I was forced to go to my employees to have a difficult discussion about furloughs.
Two of my employees volunteered to take the furlough. One was going to go back to school online anyway and told me that they would just take time off a few months early and collect unemployment. The other employee lives with someone who works in tech and has worked remotely for years. They told me that they would take time off to spend more time with their kids since financial were okay and would file for unemployment.
With those two volunteer furloughs and my one firing, I was back down to 3 employees now full time. I’ve applied for the PPP through another bank and with the second stimulus package was given the money. I’ve realized that this was the death nail for me doing business with WF. I’m moving my accounts to another bank in light of how they treated me with the PPP.
Credentialing has hit a standstill. My third employee was supposed to start soon but we are not hearing back from insurance companies about credentialing. I suspect their start date is going to be delayed.
My other physician employee is currently on Maternity leave and is essentially not collecting a salary for the time.
I have foregone my compensation for now until things get more steady.
Trump has announced in March that Medicare would treat telemedicine appointments just like a face to face visit. COVID-19 cases would often be 100% covered without a copay.
This has been a huge boost to our business and kept our doors open. However, individuals with high deductible plans often times are not paying. Their argument is that they can go online and do a telemed visit for as low as $20 sometimes and they don’t see why they have to pay more to see me via video. They don’t see the value there and we find that they are now refusing to pay.
We have found collections to be very difficult for telemedicine visits for patients who have high deductible plans.
I think it will have its place in the future, but I’m looking forward to going back to face to face visits in the future.
Current State Of The Clinic
We are now back open to face to face visits after over a month of no face to face visits.
Business at its lowest was down 70%. Now, I’m down about 20%. Things seem to have glimmers of hope. I’m seeing about 90 to 100 patients a week
We are still on track to move into the new building June 2020. I still believe in the long term vision and hopefully that in the end, we will all make it though okay.
All of my patients who were diagnosed with COVID-19 (about 60) at this point are all doing well. My employee was the only one to end up in the hospital. Everyone else had a very mild course.