Last updated: 20 April 2020
Coronavirus and COVID-19 have turned our lives upside down. You could blame the news, governments or even the public’s response. Social media perpetuates panic and misinformation quicker than Coronavirus spreads.
Surely there are things that could have been done differently by all involved; but these are largely uncharted waters, and here we are… Regardless.
The bad news
The bad news for private practice owners is that it will probably get much worse before it starts to get better. Even after that, it will be a long time before things are back to normal. We are all severely unprepared for this and its flow-on effects on our businesses and economy.
This is new territory; one would expect everyone to be confused. Confused and panicked people make bad decisions (like hoarding toilet paper). So panic seems to be the real problem.
Patients will cancel appointments. New patient enquires will dwindle. While very few clinics will continue to operate with minimal impact, more than 50% of clinics will lose more than 50% of their revenue by most optimistic estimates. Many clinics will be forced to let go of staff or even close their doors because they don’t have at least 3 months’ operational cash reserve in their bank accounts.
The good news
The good news is that this will pass, even if like a kidney stone. Panic will cease and recovery will sprout. Businesses will reopen and the public will venture outside again. Normality will return even if it takes many months, perhaps more than a year.
Have you ever thought to yourself “I wish I knew 10 years ago, what I know now”? What would you have done differently? Surely there are things you know that you should have been doing in your business but never got around to. What are these?
Next, ponder what things could have looked like for you today, if you had in fact done what you know you should have done…
Because the other good news is that this whole thing has levelled the playing field for many industries. This is happening to everyone, not just you. It’s an awesome opportunity for a rebirth, a chance to rebuild your business in your ideal image and do things right.
What will you do?
Nobody is happy that this is all happening. But it presents you and me, and other business owners with two choices.
A) Will you be paralysed by fear and bury your head in the sand? Will you spend the coming weeks and months taking an unpaid holiday at home, watching the news, forwarding Corona-memes to friends, while you secretly wallow in misery? Will you add to the panic by sacking your staff (possibly losing them to the competition)?
B) Will you keep your eye on the bigger picture and take action, knowing that you will come out stronger on the other side of this thing? There is a bucketload of things that we can do today, to come out sprinting on the other side, while others are just thawing out.
Were we prepared for this crisis? No.
Can we prepare for when it’s over? Hell yeah.
If you do nothing, you will face the same fate and slow-recovery as every other business. But by choosing to see what’s happening as an opportunity, mitigate your business against losses and preparing for the up-turn, you could be far ahead a year from now. A small change in your trajectory now could completely change where you end up.
Time to get creative and take massive action
Pedalling faster before you get to the hill will get you over the incline easier and with more energy remaining, while everyone else starts from zero. How much you lose and how long your recovery takes depends on what you do now.
Stay open and reduce appointment cancellations
Patients are booked in because they need you; everyone is more sedentary (staying at home) than ever. You know better than anyone that pain and a sedentary life can increase one’s odds of getting sick. There are countless memes and jokes in social media about how we will all come out of this crisis unhealthy, unfit, immobile and having gained weight. Your community and patients are already struggling with these issues both physically and also in their minds.
You must do all you can to prevent cancellations, provided it is appropriate. In addition to their appointments, your patients need your guidance, professional advice and regular check-ins. They need you to be proactive now, more than before. Keeping your community healthy is what you do; so take charge, be professionally assertive and lead your patients and community towards what they need at this time. You will be doing everyone involved a favour.
If you take cancellations sitting down, you risk sending the message that what you do for your patients is not so important.
Let your clients and patients know you are open
With most businesses being shut down, your community, clients and patients may simply assume you are also closed for business, or that they can’t leave their house to see you. You will first need to get ahead of this through appropriate communication. Let everyone know you are open and available to help them. This is the first step to ensure your appointments continue.
Take away the fear
Your patients will cancel appointments primarily of fear of catching the virus. They may consider your clinic to be like a general practitioner doctor’s clinic. They worry there are many sick people waiting around, ready to spread the virus; which is not the case.
Another reason for cancellations will be for the government’s “stay at home” order. It is a good idea to remind your patients that stay home orders do not apply to essential services. However, note that whether your business is included in the definition of an “essential service” may change.
You can’t control everything going on, but you can control your patients’ experience and your staff’s interactions with them.
First thing first: Provide a safe, hygienic environment for your patients.
Take a look at this checklist.
Then call every one of your current patients individually, even if they have no upcoming appointments, but especially if they have cancelled in the last few weeks. Let them know you are open, and what you are doing to eliminate risks. Let them know you are in control and they are safe. Give them certainty in this time they need it most. You should also introduce Telehealth options if you are offering it.
If you want to send pre-recorded messages, it may be easier to use something like WhatsApp / Messenger / iMessage.
When patients call you to cancel, they have already decided their fear is real. Start with an acknowledgement of the fear, with an “I understand your concern, we hear this a lot”. Then, let them know all the things you are doing to eliminate risks, PLUS new Telehealth options to ensure continuity of care. Lastly, simply ask “What do you think?”
You can use video to excellent effect
Here’s what one client did to help their patients feel comfortable:
Make follow-up bookings
Encourage patients to re-book and keep future appointments. Remember: if they need you and you are not booking ahead, you are not doing them any favours by letting them suffer in pain or resigning to the idea that the world is coming to an end.
Check-in regularly with your patients, via email, phone or text. Show your patients that you are there for them, even though this tough time. It will take time, but this is important for your patients and the future of your business.
Telehealth is a convenient way for you to conduct a consultation with your patients remotely via online video. With the right technology, you can do many of the things you would do if you had an in-person appointment at your clinic. Telehealth can work very well for ongoing evaluation and management.
Telehealth is still relatively young in practical terms, so there are still many unknowns and varying degrees of acceptance and implementation by health systems, health professionals and the public. However, in the face of this crisis, it may be a viable alternative to in-clinic treatment of patients. By now, patients will be more readily accepting of the Telehealth concept, especially those choosing to stay home.
Definitions of what Telehealth is, how it is to be implemented and regulated, its recognition and coverage by medicare or insurance all differ from country to country (or even state to state). Please research your options thoroughly.
Best way to approach the introduction of Telehealth to your practice is to think of it as improving your services and patient care. This notion will help you design and implement your strategy. Don’t look at it simply as installing a piece of technology.
As experienced as you are in treating patients, Telehealth is probably brand new to you. Consider that with uptake of Telehealth, many types of routine follow-ups may well be done via video in the future. There is much to learn and experiment with. Managing your expectations will help, as all this will take time to get right.
Change creates opportunity
Although Telehealth is still relatively young, it’s nothing new; It simply lacked pace and acceptance as a viable alternative to in-clinic appointments. However, it has gained incredible attention and traction for all involved, with the advent of COVID-19.
The crisis is fast-tracking many state and federal laws around the world, including those around healthcare and Telehealth. At this rate of uptake, it is absolutely likely that Telehealth becomes and remains a mainstream offering, even after this crisis is over.
If you are not looking at Telehealth as an alternative right now, you could be well behind the curve when this crisis is over.
For some, it’s a way to survive.
For others, it’s a new profit centre.
If access to the Internet is limited or Internet speeds are slow in your target demographic, or your primary patient demographic is the “severely technologically-challenged”, you may have to rethink the design of your program.
The technological aspects of Telehealth can be very simple, requiring patients to click a single link to start the appointment. However, if your patients are completely shy from technology and can’t follow basic instructions like placing their device propped up on a desk, your end to end consultation process may be more time-consuming. You then have to decide if this format is still financially viable for you.
Concerns around effective delivery of treatment
There are obvious concerns from you and the patient, around the efficacy of services rendered where hands-on work or special equipment is required. But you will both be highly motivated to make it work if you are solving a pressing problem that they face.
Imagine a near-future where COVID-19 has reached a far greater proportion of the population, and it is no longer safe for you to deliver your services in person. What would this mean to your patients, if Telehealth options were not available?
Sending your patients a letter to tell them about your Telehealth service is an excellent idea. Discuss why you are going down this path, what tools you will use, how the sessions will be organised and delivered etc.
What this crisis has done is to force all involved to look at the tradeoffs between the benefit of somewhat restricted treatment versus harm of not treating. You need to explore and pioneer methods and approaches that work for evaluation and treatment that yield positive results.
The opportunity here is that by the time we come out of this crisis, Telehealth will become a significant channel for health service delivery. It will be well accepted and regarded by medicare, insurance companies, associations, the public and therapists alike.
Is your patient appropriate for Telehealth treatment?
You already have extensive training in your degree about risk management. You know how to evaluate risk in clinical situations and use clinical reasoning and judgments on a daily basis to guide interactions with patients to minimise risk. You are equipped to make these calls.
The general recommendation is to start small, get familiar with technologies and the process. You can then evolve your workflow to suit your needs and that of your patients. Though there is some best practice available, there is no one size fits all solution.
- You will need a computer with a good camera. A smartphone will be too small and limiting. Tablet is fine but you will need a hands-free stand will help you adjust the camera angle because you will need to remain in the camera frame as you move about or stand to demonstrate movements.
- A Bluetooth microphone and headset will help with clear audio, especially when you are demonstrating something while standing further from your computer or tablet.
- Ensure your room is private and well-lit. Don’t stand with your back to a window, or directly under the strong ceiling light. Avoid distracting backgrounds behind you.
- A reliable and fast Internet connection is a must. Run a speed test of your Internet speed here. If you are getting less than 10 Mbps download or upload, then your video quality may suffer. You will want to upgrade your Internet plan.
For your patient
Your patient will need similar hardware. However, they can get away using a smartphone or if they don’t have a wireless microphone/headset.
There are several options for Telehealth platforms, and they are rapidly growing and improving during this time. Some key considerations are:
- Ease of setup for you (i.e. creating and controlling the meeting space and sending the invite link).
- Ease of setup for your patients. The last thing you want from a patient in pain is to fumble with technology, downloads, installation or passwords.
- Reliability and stability.
- Features (e.g. disclaimer management, recording capability, scheduling, payment processing, patient management, integration with practice management software etc).
- Privacy and security of the call and any recordings.
- A pricing model that suits your call volume.
Here are a few platforms to consider:
- PhysiTrack (get a few bucks off when you use code PP20)
- Google Meet
- Skype for Business
- Zoom for Healthcare
Several front-desk management systems are also integrating Telehealth features into their patient management platforms.
To get started free and without any account setup, you might like to experiment with AppRTC. Powered by Google, it uses HIPAA compliant WebRTC technology for realtime video conferencing without any additional plugins.
- Go to https://appr.tc/
- Enter a unique “room name” (e.g. patient name) and click JOIN. Your browser will ask you for permission to access your camera and microphone on the first occasion. You need to allow this.
- Once you can see your face in the browser things are working properly. Copy the URL from the browser’s address bar. This is your private virtual room URL; this is what you share with your patient
- When it is time for their appointment, your patient simply taps or clicks on the room URL that you sent to enter the room on their device. Patient’s browser will ask them for permission to access to their camera and microphone on the first occasion. They need to allow this. No installation required.
- When two people are visiting this room URL at the same time, they will be “in the same room”. I.e. you will be able to see each other.
At your next appointment, you can reuse the same room URL. You can also create a new URL if required, but you will need to share the new URL with your patient, as before.
Another similar and free service is meet.jit.si, which offers a few additional features.
Note that during this time of crisis, many laws and regulations around Telehealth and privacy (HIPAA, GDRP, Privacy Act etc) are being relaxed to facilitate the public’s access to health services remotely. Usual restrictions are being overlooked, to allow practitioners to start treating quickly and cheaply using more common channels such as FaceTime, Skype etc.
Remember that under normal circumstances privacy and compliance is very strictly regulated, so it’s a good idea to start out with proper tools where possible and be compliant from day one. If you are looking into Telehealth now, chances are you will be offering it even after this crisis. So it makes sense to get set up correctly.
Any tool that can be accessed by the public, whether recorded or live (e.g. Facebook Live, YouTube Live, TikTok) must not be used.
Medicare and insurance are lagging behind when it comes to covering Telehealth. Depending on where you are in the world and how fast changes are pushed through, you may be better off focusing on cash-only payments. There are practices thriving out there, doing cash-only Telehealth.
Your in-clinic payment process won’t apply here. You need to consider the logistics behind asking for and receiving payments.
- Determine how you will collect payment. Will you use PayPal or Stripe for online payments? Can you direct your patients to a secure payment page on your website?
- How will you confirm correct payment was made? How will you handle refunds if necessary?
- Will you require payment before or after treatment?
Pricing your telehealth services
Whether you are approaching Telehealth as a “transitional” or “long term” solution will probably play a role in your pricing structure. What subset of your services will you offer? Will you adjust pricing for Telehealth? Will your video-based sessions be shorter in duration than typical sessions? There is always a cost to you for the delivery of your services, like rent, bills, staff salaries etc; will the delivery of Telehealth services cost you less than if the service was in-clinic?
Typically speaking, you shouldn’t discount your services if the value and benefit provided has not diminished. The Coronavirus crisis has impacted everybody; both you and also your patients. Would you consider a temporary “reduced fee structure”, in return for goodwill and practical Telehealth experience?
Double-down: Work ON your business
We hear some version of this from Private practice owners ALL THE TIME:
“I have no time to work on my business because I’m always working in my business”.
When things are quiet is the best time to get all this done.
Are there processes you can document in your business? Anything around administration, recruitment, systems, referrals, management and so on… I.e. all those things that you have been putting off can now be done and polished during your quiet time, ready for the upturn.
What are your marketing plans? How are you generating leads? Do you use telephone scripts? Do you need to review these? Do you have a patient retention plan? Does your pricing need a review?
Get your team on board with everything. How are they communicating with patients? Are they working actively to curb appointment cancellations and continue booking future appointments? Do they have any ideas of their own? Is there anything they can put up their hands for? Working on these things together with your team means better success at implementation and adhering to them.
Do you need to talk with us about your website and online strategy? You have access to a ton of resources through PracticePulse; consider us a part of your team.
Going back to the question: What would you do differently, knowing what you know now? Getting started now on what you should be doing, will mean you will have more insights, experience and data to work with and do things differently as you emerge on the other side of this dark time.
Seek new opportunities
Having multiple streams of income are immensely valuable in times like this. If you’ve never thought about this before, spend some time brainstorming what else you can provide that your patients and communities need now. Could you provide at-home group classes of some sort that involve the whole family via a video conference link? Could you safely provide in-home therapy services for vulnerable patients?
Sometimes our egos and fears get in the way, supporting a rigid frame of what we should be offering in our business. But remember; you need to go where your customers are and supply what they want. Test out new ideas and see if they stick. You may uncover viable income sources that continue to work for you long after this crisis is over.
Change your marketing gears to focus on value
Right now, the public is looking for people with authority for reliable information, certainty and optimism. It is a fantastic opportunity to become that person in your community and work to reduce panic.
Focus on maintaining relationships with your patients, community, referrers and staff. This will be the natural foundation for opportunities after the crisis.
Consider giving away free 10-minute phone consults. Overdelivering valuable advice, without intent or view of monetary return, is an excellent way to fill your otherwise quiet times, as well as build massive amounts of authority and good-will.
Write and share blog posts, send e-newsletters, call your patients, write articles for your local newspaper, share valuable social media posts, address burning questions. Provide massive amounts of value to your patients and community.
Marketing is not simply convincing someone to buy your services. If you are getting into Telehealth, you will quickly find just how much education and hand-holding is required to get your patients comfortable with such a paradigm shift. More your patients understand the what, why and how, more they will trust you and better the outcomes you can deliver.
There are endless other topics you can cover, such as:
- Avoiding COVID-19
- How to work from home
- Home workstation setup
- Correct posture
- Exercising at home
You can even share relevant news and light-hearted, positive messages, as well as reassuring messages about how you put safety first and remain open.
Start building your email list, if you haven’t already done so. Provide such valuable material, that patients look forward to your emails. An incredible amount of regular communication is needed in times of emergency.
Social isolation measures will result in an overall lack of physical activity. There will be a big demand for your services after the crisis. Be ready to serve as quickly as possible.
More you communicate, faster your recovery from this crisis and lower your financial loss will. be. Ramp up your communication even more, just before you reopen.
Get experience with social media, Facebook and Google Ads
Bring yourself and staff up to date. With social media usage on the rise, if you’ve been avoiding it this whole time, it’s an opportunity to learn and master social media for business.
Facebook, Instagram and Google ads are dynamically priced, based on demand from advertisers. Fewer businesses advertising these days means placing local ads will be cheaper. It is an excellent time to get your feet wet and experiment with advertising on these platforms.
Seek financial assistance
Governments are currently offering various packages, subsidies, tax breaks and other financial assistance to small business owners. Ensure you research and apply for any assistance you may be eligible for.
Examine your personal reserves and lines of credit to help pay for your core expenses and marketing. You may be eligible for special loans with low-interest rates and repayment terms.
Negotiate some form of rent relief with your landlord, such as a number of payment-free months or some discounted rate. This may require an extension of your lease or some other consideration.
Also, check whether your insurance covers any loss of revenue.
Update your website
We are working remotely and with additional hours. Are you still open? Have you changed your business hours? Are you offering Telehealth? What safety measures are you implementing in your clinic? You have a lot on your plate right now. So feel free to offload all your website updates to us.
Update your website to keep your patients informed.
- Create a landing page about what you are doing, if you are open and offering Telehealth.
- Explain how Telehealth works, provide form downloads, online appointment bookings etc.
- Place prominent banners and call-to-actions on your website.
- Upload blog posts and ongoing news / educational material.
- Contact us for ideas and an audit.
We know things are crazy and you are busy right now! Let us handle your website management and updates. We are here for you.