Overview of Closure and Reopening Processes
Many office practices were ill-prepared for the urgency and abruptness of the COVID-19 related responses. This included the most basic tasks of determining essential versus optional staff members, informing patients of canceled appointments and office closure, and creation/implementation of social media announcements. As the restrictions eased and were reimposed in various geographic locations, this became an even more complicated and fluid situation adding to the complexity of the situation.
Many have reported that during the reopening process, they have been inundated with the backlog of patients requiring urgent appointments for medical treatments. Coupled with individuals weary of a long period of quarantine and are viewing the “work at home†scenario as the ideal time to consider aesthetic options, office staff are feeling overwhelmed by client demand. These situations are compounded by a staff or some isolated staff that may be reluctant to return to work, the riskmitigation processes required to obtain sufficient amounts of PPE, and scheduling practices to allow enough time between appointments for room disinfection and cleaning. Following a prolonged period of closure, the staff may appear a bit “rusty†and will likely require extra time to become comfortable in their work environment. In addition, to protect staff as well as patients we are obligated to limit the number of persons, including caregivers and family members, in the examination/ treatments rooms.
The following sections provide guidance in four generalized areas. These are: Practice Management that includes guidance regarding office record practices and procedures and financial considerations; Supplies and Inventory that focuses on the need to maintain PPE and adjunctive infection control measures; Office Staffing Considerations and Protocols to minimize staff disruptions; and Patient Management Strategies that involve notifications of office closures and reopening procedures.
Practice Management
In the case of COVID-19, practice management included gating decisions of when it was permissible and prudent to reopen. This was informed by applicable federal, state, and local government mandates, which also determined the permissibility of certain greater contagion-risk procedures. For future emergency situations, practices should consider, at a minimum, their local government mandates for office procedure guidance. The following sections summarize selected practice management policies and procedures that may ease the process of office closure and reopening.
Office Record Policies and Procedures
Good office medical record policies and procedures include the routine back-up and remote accessibility to all office records including appointments, patient files and photographs, and other critical information and documents. It is advisable to have two methods of data/information back-up with one being on-site and one being off-site/cloud storage. It is also advisable to have hard-copy versions of critical information in cases of internet/ electrical failures.
The office lead administrator should maintain a complete listing of all log-in information and passwords needed for access to various sites. This includes social media sites and other webrelated office information (eg, email account passwords and account numbers).
A current listing of all office insurance policy contacts (eg, liability, umbrella, medical malpractice, personal property, etc.) for prompt notification in cases of emergency should be readily accessible. The vendor(s) for PPE and other emergency supplies should be included in this contact listing. Contact details for local, national, and international colleagues who may be able to assist in situations of personnel shortages, answer questions, or provide other types of information/guidance, may be helpful. To provide disaster-related information and guidance, contact details for reliable sources such as the Centers for Disease Control and Prevention (CDC), state and national agencies such as FEMA (federal emergency management agency), DPH (department of public health), DOL (department of labor), etc. and other relevant information sources are essential.
Emergency office closure situations demand prompt notification to staff, patients, and vendors. Offices should maintain a current listing of staff members, their preferred contact information, and, if possible, emergency contact information. Using social media or other types of contact, it is often helpful to have a set of pre-written office-related information that can be quickly disseminated to affected entities. For patients, the prompt and regularly updated information will assist in reengaging patients following resolution of the situation (e.g., website, social media, outgoing phone message).
Financial Considerations
The COVID-19 crisis has had a significant negative impact on clinical practices with some closing permanently and others suffering potentially irreversible financial hardship. Financial survival is clearly a major challenge. Physician owners should have a good understanding of their key performance indicators (KPI) and the metrics related to cash flow and cash reserves. If possible, there should be a plan for on-line generation of revenue (ie, product sales through practice website) and other potential revenue streams to supplement the inability to perform aesthetic procedures and see patients in-clinic.
The practice lead administrator/physician owner should have a close relationship with the financial institutions that are able
Many office practices were ill-prepared for the urgency and abruptness of the COVID-19 related responses. This included the most basic tasks of determining essential versus optional staff members, informing patients of canceled appointments and office closure, and creation/implementation of social media announcements. As the restrictions eased and were reimposed in various geographic locations, this became an even more complicated and fluid situation adding to the complexity of the situation.
Many have reported that during the reopening process, they have been inundated with the backlog of patients requiring urgent appointments for medical treatments. Coupled with individuals weary of a long period of quarantine and are viewing the “work at home†scenario as the ideal time to consider aesthetic options, office staff are feeling overwhelmed by client demand. These situations are compounded by a staff or some isolated staff that may be reluctant to return to work, the riskmitigation processes required to obtain sufficient amounts of PPE, and scheduling practices to allow enough time between appointments for room disinfection and cleaning. Following a prolonged period of closure, the staff may appear a bit “rusty†and will likely require extra time to become comfortable in their work environment. In addition, to protect staff as well as patients we are obligated to limit the number of persons, including caregivers and family members, in the examination/ treatments rooms.
The following sections provide guidance in four generalized areas. These are: Practice Management that includes guidance regarding office record practices and procedures and financial considerations; Supplies and Inventory that focuses on the need to maintain PPE and adjunctive infection control measures; Office Staffing Considerations and Protocols to minimize staff disruptions; and Patient Management Strategies that involve notifications of office closures and reopening procedures.
Practice Management
In the case of COVID-19, practice management included gating decisions of when it was permissible and prudent to reopen. This was informed by applicable federal, state, and local government mandates, which also determined the permissibility of certain greater contagion-risk procedures. For future emergency situations, practices should consider, at a minimum, their local government mandates for office procedure guidance. The following sections summarize selected practice management policies and procedures that may ease the process of office closure and reopening.
Office Record Policies and Procedures
Good office medical record policies and procedures include the routine back-up and remote accessibility to all office records including appointments, patient files and photographs, and other critical information and documents. It is advisable to have two methods of data/information back-up with one being on-site and one being off-site/cloud storage. It is also advisable to have hard-copy versions of critical information in cases of internet/ electrical failures.
The office lead administrator should maintain a complete listing of all log-in information and passwords needed for access to various sites. This includes social media sites and other webrelated office information (eg, email account passwords and account numbers).
A current listing of all office insurance policy contacts (eg, liability, umbrella, medical malpractice, personal property, etc.) for prompt notification in cases of emergency should be readily accessible. The vendor(s) for PPE and other emergency supplies should be included in this contact listing. Contact details for local, national, and international colleagues who may be able to assist in situations of personnel shortages, answer questions, or provide other types of information/guidance, may be helpful. To provide disaster-related information and guidance, contact details for reliable sources such as the Centers for Disease Control and Prevention (CDC), state and national agencies such as FEMA (federal emergency management agency), DPH (department of public health), DOL (department of labor), etc. and other relevant information sources are essential.
Emergency office closure situations demand prompt notification to staff, patients, and vendors. Offices should maintain a current listing of staff members, their preferred contact information, and, if possible, emergency contact information. Using social media or other types of contact, it is often helpful to have a set of pre-written office-related information that can be quickly disseminated to affected entities. For patients, the prompt and regularly updated information will assist in reengaging patients following resolution of the situation (e.g., website, social media, outgoing phone message).
Financial Considerations
The COVID-19 crisis has had a significant negative impact on clinical practices with some closing permanently and others suffering potentially irreversible financial hardship. Financial survival is clearly a major challenge. Physician owners should have a good understanding of their key performance indicators (KPI) and the metrics related to cash flow and cash reserves. If possible, there should be a plan for on-line generation of revenue (ie, product sales through practice website) and other potential revenue streams to supplement the inability to perform aesthetic procedures and see patients in-clinic.
The practice lead administrator/physician owner should have a close relationship with the financial institutions that are able
