Altair Health has been providing life-saving care in the state of New Jersey since 1958. We have grown significantly since that time, and Altair Health now employs nearly 150 people — providing them with health care and retirement benefits, as well as rewarding work taking care of patients with neurosurgical disorders. The current pandemic has been a stark reminder that we are, after all, a small business dependent on professional reimbursement to keep our team and their families safe and employed during this crisis.
New Jersey has been hit hard by COVID-19. The hospitals where we provide care have been forced to convert their intensive care units (ICUs) to accommodate those with respiratory distress from COVID-19. These hospitals have also stopped elective surgical procedures from being performed. We are also unable to accept some emergency cases because of a lack of ICU beds. As of March 2020, per a state executive order, our ambulatory surgical center has been closed for all elective procedures, thereby crippling our ability to perform procedures. As a surgical practice, the vast majority of our revenue comes from elective and emergent surgeries. The current COVID-19 crisis has led to a massive loss of revenue.
Our physicians, nurse practitioners and physician assistants are on the frontlines of dealing with this crisis. We are exposing ourselves and our families to a potentially life-threatening condition every time we provide care to patients infected with COVID-19. Despite the selfless efforts of our health care providers, we are faced with the prospects of the difficult decision of having to lay off the people risking their lives. These practitioners are the very people that are needed during this crisis. With limited revenue coming in from surgical procedures, we are also faced with the difficult decision of what we do with our employees and are considering layoffs or furloughs to maintain liquidity.
Many surgical and medical practices are faced with similar challenging circumstances as they face cash flow shortages. To maintain practice liquidity, the following actions may be deployed:
- Hold board meetings on a nearly daily basis;
- Monitor key metrics weekly to understand the impact on the practice — for example, we currently have a 65% or higher cancellation rate for surgery and a 90% or higher cancellation rate for pain management;
- Create a de novo Virtual Health Program for new and established office visits — we have gone from zero virtual visits to a 90% rate of virtual visits;
- Implement virtual physical therapy to keep patients as conditioned as possible while adhering to mandatory stay at home policies;
- Screen patients to prevent potential COVID-19 positive patients from entering our facilities;
- Follow the Centers for Disease Control and Prevention (CDC), state and hospital recommendations regarding best practices for screening patients and staff to ensure a safe clinical environment for all;
- Use risk algorithms to triage patients to emergent, urgent, essential and elective status to ensure patients are treated as appropriately as possible;
- Develop a 13-week cash forecast model to monitor our liquidity position;
- Request a 6-month deferral on medical malpractice insurance premiums;
- Reduce all non-essential expenses;
- Pursue rent abatement from landlords;
- Delay pension contributions in the short-term;
- Defer all bonuses to maintain cash flow;
- Pursue multiple financial relief programs to enhance liquidity, including the Small Business Administration (SBA) Paycheck Protection Program (PPP), the U.S. Department of Health and Human Services (HHS) grant program and the Medicare Accelerated and Advance Payment Program; and
- Evaluate partial furlough/layoffs, but try to make this the last option.
Looking beyond the current pandemic, there are lessons we have learned that may help us overcome future challenges. Principal among those is the potential for greater utilization of virtual health care visits. We have been able to rapidly increase virtual health to provide comfort and continued care to our patients at a time when direct patient care is not possible. While physical exams remain an integral part of our evaluation, the ability to provide patients with access to virtual care will be an essential part of our armamentarium to address similar challenges in the future.
Hopefully, the lessons we learn during this crisis will allow us to strengthen our practices going forward.
Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.
Scott A. Meyer, MD, FAANS
Treasurer, Altair Health