Contributor: How Independent Community Practices Remained Resilient Over the Last Year

Every year, millions of Americans rely on independently owned and operated specialty practices for care in their communities, ranging from ophthalmology, rheumatology, and gastroenterology to neurology, oncology, and more. Throughout the COVID-19 pandemic, these practices were integral in helping patients access chemotherapy and other critical treatments, participate in clinical trials, and screen for serious diseases. However, the pandemic also presented significant challenges to them, their operations, and their patients.

Within the first months of the pandemic’s “stay at home” orders, community-based physicians saw a 40% drop in new patient visits as well as a 100% increase in cancellations and no-shows.¹ Lower patient volumes created new financial constraints for these providers, and as a result, 50% of private practices had to furlough office staff. Almost 25% were forced to make permanent layoffs.² While many patients eventually returned—either in-office or through telehealth—the pandemic illustrated how nimble specialty physician practices need to be to protect their businesses and remain viable resources to their community. Community practices can position themselves for future success if they apply the lessons these sites of care learned from the pandemic. The most successful practices adjusted workflows to meet patients where they were; expanded services to generate additional streams of revenue; and worked with their teams to control inventory costs.

Matching workflows with patient needs

During the height of the pandemic, 64% of patients were unlikely to visit a specialist for fear of contracting the virus.^1,3 This caused many patients to miss important—and in some cases, life-saving—screenings or treatments, and many independent specialty practices were not only concerned about patient outcomes but also facing significant cash-flow challenges.

As a partial solution, many practices turned to telehealth to minimize patient care disruptions and accommodate patients who weren’t comfortable returning to the office for appointments. In fact, IntrinsiQ Specialty Solutions found that 79% of its community-based practices integrated telehealth services within the first few months of the COVID-19 pandemic.⁴ Some procedures, however, could not be completed virtually, so specialists also found new methods to deliver their services in a way that increased or addressed patient comfort. For example, some physicians began administering injections and holding follow-up appointments in their parking lots. Other specialty practices implemented new workflows, such as adding additional blood-draw stations or placing a scheduler in the treatment suite, so they could reduce the number of patients in waiting rooms or other small spaces for extended periods of time.

Expanding services and streams of revenue

While the pandemic forced physician practices to approach their workflows creatively, it also required new thinking about the services specialists offered their communities. Independently owned and operated practices are well positioned to have a deep understanding of what is happening within their patient populations and have the local relationships to adapt and tailor services accordingly. This flexibility creates opportunities for new streams of revenue, which in turn protects their ability to provide services for the community long term.

For example, at the beginning of the pandemic, many rural communities were looking for more providers to help with testing and monitoring of essential workers at businesses that were central to their economic growth and stability. Gabrail Cancer Center, an independent community oncology practice in Ohio, identified an opportunity to serve its community and increase its revenue by partnering with local food processing plants to implement screening and health care support. These services were desperately needed as many food businesses across the country were experiencing COVID-19 outbreaks. By the summer of 2020, Gabrail Cancer Center was supporting 8 food processing plants on a 24-hour, 7-day-a-week basis, helping those plants avoid shutdowns. Additionally, with this ongoing demand for care and services, Gabrail hired and employed more than 30 highly qualified providers who had been furloughed or laid off from other local hospitals.

Controlling inventory costs

With such fluctuation of patient volumes—whether initially as patients avoided appointments and then returned, or because of expanded services that brought new patients into the practice—COVID-19 shined a light on the importance of inventory management and having a backend staff team that can move in real-time with inventory needs. Early in the pandemic, many physicians were left with excess inventory after they ordered products based on their typical pre–COVID-19 patient volumes.⁵ Now, many independent practices are wondering how much inventory they will need moving forward, as tens of thousands of Americans may have gone undiagnosed this past year and are, therefore, unknowingly not getting the treatment they need.

Providers cannot warehouse large quantities of drugs, nor do they have space to stock rarely needed, yet patient-critical, medicines. Physicians need the appropriate medications on hand to treat their patients, but if they carry too much product for too long, they’re financially liable for the inventory that they aren’t able to bill. During the pandemic, practices with a reliable backend staff and grasp on inventory continued to monitor daily dispenses, understand the daily caseload, and anticipate inventory needs. Knowing this information made it easier to communicate with their group purchasing organizations or wholesalers, who could also provide support—and, in some cases, extended credit terms to allow physicians more time to exhaust inventory prior to billing or adjust allocations moving forward.

Specialty community practices will continue to be important sites of care—especially for rural areas—and without them, many Americans would be left in health care deserts. We need to protect these important care sites and make sure the lessons COVID-19 taught us are implemented moving forward. We must continue to share strategies and tactics that have helped independent practices remain resilient during the COVID-19 pandemic, so more of these businesses can get back on their feet and continue evolving and serving their communities, no matter what challenges could lie ahead.

References

1. Yermal B Jr. Amid pandemic, public wary of seeking non-coronavirus care from providers. Morning Consult. May 7, 2020. Accessed April 19, 2021. https://morningconsult.com/2020/05/04/coronavirus-health-care-providers-polling/

2. Bin Han Ong M. COVID-19 vs. community oncology: Flatiron's data provides first damage assessment. The Cancer Letter. May 1, 2020. Accessed April 19, 2021. https://cancerletter.com/the-cancer-letter/20200501_1/

3. Besse M, Harrison L. The vital role of community practices in delivering care through a pandemic. AmerisourceBergen. July 1, 2020. Accessed April 19, 2021. https://www.amerisourcebergen.com/insights/physician-practices/the-vital-role-of-community-practices-in-delivering-care-through-a-pandemic

4. IntrinsiQ Specialty Solutions. The early impact of COVID-19 on specialty practices. AmerisourceBergen. August 20, 2020. Accessed April 19, 2021. https://www.amerisourcebergen.com/insights/physician-practices/the-early-impact-of-covid-19-on-specialty-practices

5. Dodd J, McGowan K. The now normal, part 2: getting your practice future-ready. AmerisourceBergen. July 1, 2020. Accessed April 19, 2021. https://www.amerisourcebergen.com/insights/physician-practices/getting-your-practice-future-ready

6. Specialist and private practices take severe blow during pandemic. American Hospital Association. Accessed April 19, 2021. https://www.aha.org/aha-center-health-innovation-market-scan/2020-09-01-specialist-and-private-practices-take-severe