Medical News recently spoke with local finance executives who discussed navigating through the COVID-19 pandemic.
Medical News: How has the COVID-19 pandemic impacted your business operations?
Craig Collins, Vice President and CFO, UK HealthCare
As with most healthcare organizations, COVID-19 has had a major impact on UK HealthCare’s (UKHC) revenue related to patient volumes and patient-care services because of temporarily discontinuing elective surgeries earlier this year.
Through careful planning, we are focusing on safely restarting elective surgeries and patient care clinic appointments by limiting access points and screening visitors and staff for symptoms of COVID-19 prior to entering UK HealthCare hospitals and individual clinics within ambulatory facilities. We are also limiting the number of people accompanying patients.
We are currently working on a plan that evaluates which staff will continue to work remotely and, when safe, what we will need to provide in our current office locations to maintain social distancing.
Dana Hendricks, CFO, ProAssurance
After the successful transition of over 95 percent of our employees to remote work, most of our operational changes were in support of our medical professional liability insurance and workers’ compensation customers who were impacted more directly by the pandemic. For example, the decisions by state regulators to temporarily suspend elective medical procedures affect both a medical practice’s ability to pay expenses, including insurance, and their liability exposure. We made significant operational changes to be responsive and financially flexible for our customers, and to analyze/apply discounts as warranted by reductions in exposure. Because both medicine and insurance are highly regulated industries, simply keeping up to date and in compliance with each state’s COVID-19-related requirements and communicating them was a full-time job.
Adam Kempf, Senior Vice President and CFO, Norton Healthcare
Like all providers in the state, we saw a significant decrease in volume when elective surgeries were suspended in March. Combined with disruption in the supply chain for personal protective equipment (PPE), we faced significant operational and revenue challenges. As we move forward in this new environment, we continue to offer expanded office hours and telehealth visits and continue to work closely with patients to get them scheduled for procedures or screenings that may have been postponed.
Steve Oglesby, CFO, Baptist Health
The loss of revenue due to lower patient volumes and the additional expenses from higher prices for and utilization of personal protective equipment (PPE) and COVID-19 testing has had a dramatic impact on our financial results. We have received grants as part of the CARES Act, but they have only partly offset these losses. As a result, we are watching our expenses very closely and making reductions where we can, while keeping patient safety and quality of care as our top priorities. As part of that, we have modified workflows used particularly with special need patients (including those who indicate positive for COVID-19). We have added staffing to screen both patients and employees entering our building. Importantly, we invested heavily in digital medicine approaches for both visits and patient interactions. We continue to monitor our capacity and ability to handle a surge. In some areas, we are staying open on weekends and evening hours to capture delayed revenue.
Steve Oreskovich, CFO, Waystar
Waystar works with hospitals, providers and health systems, offering cloud-based technology that simplifies and unifies the healthcare revenue cycle. When stay-at-home orders went into effect starting in March, our healthcare claim volume from physician office visits and elective procedures declined; meanwhile, telehealth claims surged, increasing over 600 percent from February. As stay-at-home orders have generally lifted, visits and elective procedures have risen close to pre-pandemic levels, but telehealth adoption is here to stay. The rise of telehealth, and the resulting fast-moving updates in billing codes and policies, sparked demand for adaptable, up-to-date revenue cycle platforms like ours, and we see that as a significant opportunity for our company moving forward.
Dana Royse, CFO, New Vista
At New Vista, traditionally our outpatient behavioral health services have been in person. With the onset of the COVID-19 pandemic we switched to nearly all services being provided by telehealth. From a revenue perspective, we faced a couple of weeks in March where services were down about a third during the transition to telehealth. However, we quickly rebounded to pre-COVID-19 service levels. Our staff have been our greatest asset as we have worked through implementing telehealth. The entire team knocked it out of the park when it comes to being available for our clients. The psychiatrists, therapists and case managers all embraced telehealth.
Sharon Tankersley, Senior Vice President and CFO, Hosparus Health
Hosparus Health had to maintain daily operations with minimal disruptions to continue serving our patients and families. We quickly added and implemented a software module allowing our physicians and care providers to make telehealth visits when patients or facilities restricted in-person visits due to COVID-19 concerns. Our Chief Medical Officer and Chief Operating Officer reviewed safety protocols for proper use of Personal Protective Equipment to assure that clinical care providers would be appropriately protected when making in-person visits.
We were blessed to receive funds from the CARES Provider Act and are tracking lost revenues and increased COVID-19-related expenses to file reporting requirements for use of those funds. Being a 24/7/365 healthcare provider required us to be nimble and swiftly adapt to the COVID-19 conditions while we continued to operate within the new environment.
MN: Do you believe there will be any long-term impacts from this crisis to your organization or to the healthcare industry?
Craig Collins, UK HealthCare
Yes, I do think there will be impacts both for UKHC and the healthcare industry. I see it as an opportunity to rethink how care is provided and how we can best leverage technology to shape our “new normal.” Patient flow will also need to be re-evaluated based on social distancing guidelines. All of this will need to be considered as organizations address current challenges and plan for future success.
Dana Hendricks, ProAssurance
We expect our customers will be affected more than our company, and the impacts to ProAssurance have been positive. Medmarc, our life sciences products and medical technology liability division, is an active participant in COVID-19-related innovation. Medmarc is working with clients that range from new PPE distributors to auto-industry companies manufacturing ventilators. The adoption of telemedicine will ultimately settle at a much higher level than before the pandemic, introducing new professional liability risks and benefits for us to consider. As for a medium-term impact, it is midsummer, and most state courts are still closed. When they reopen, criminal cases will take precedence over civil cases. The added delays to resolving medical malpractice allegations via the courts will likely have some impact on plaintiff behavior and the resolution of cases.
Adam Kempf, Norton Healthcare
I think all health systems have been reminded of the importance of liquidity during this crisis. While we never could have predicted this pandemic, our stringent financial planning prepared us to weather a disruption like this. It will certainly be a long recovery to restore the strength of our balance sheet, but we have started that process and are confident that we will recover. Our work with drive-thru testing, community outreach and caring for our employees has been a reminder that we are a partner in our community’s health.
Steve Oglesby, Baptist Health
Ideally, digital medicine techniques (such as Baptist Health Virtual Care for video or e-mail visits with providers) will continue to be regulatory and operationally supported which will allow us to offer as an alternative to in-person patient care. Until there is a vaccine or identifier, the cost of care will remain high as we continue with precautions.
Steve Oreskovich, Waystar
For Waystar, COVID-19 acted as a catalyst to accelerate our pace of innovation. For example, we fast-tracked the launch of our analytics platform because we felt it could benefit providers across the healthcare spectrum tremendously during this time. The platform allows healthcare organizations to more easily access and interpret the data they need during this crisis—insights that can help decompress margins, accelerate reimbursement and make financial reporting more efficient with many stakeholders now working from home. The biggest impact of this crisis on the healthcare system will be the longevity of telehealth. In a recent survey of Waystar customers, we found that 84 percent of providers offering telehealth services started doing so in the past few months, and almost all those providers plan to continue using telehealth after the pandemic ends.
Dana Royse, New Vista
I think long term we have benefited from the immersion in providing telehealth services and working remotely. Telehealth was part of New Vista’s 2020 strategic plan, but remote work was not. It has been amazing to see the script flip from a long list of reasons why working remotely cannot work to a short list of how we can make it work. We are hearing positive results from clinical and administrative staff alike on remote work. I am concerned about the long-term effects the COVID-19 pandemic will have on the mental health of all Kentuckians including: our child and adult clients, the unemployed and the healthcare workers. I know at New Vista we have seen people showing up for work, day after day, taking little time for themselves to make sure the best possible care can be delivered throughout the pandemic. At some point in the future when things are back to normal, these employees may never see normal in the same way. As an employer, New Vista is committed to supporting all staff both now as well as in the future.
Sharon Tankersley, Hosparus Health
We are learning how to best utilize telehealth to supplement patient care and increase communication with the families. Continued use of remote meetings for care provider teams allows more time for them to be present with patients. I worry rural communities will see the most long-term impact from the crisis, as they are more at risk to lose hospitals and other healthcare providers.
MN: Has this pandemic forced you and your teams to re-think your normal business operations?
Craig Collins, UK HealthCare
Yes, we had to move very quickly on how to best serve our patients by implementing telemedicine and drive-thru testing. We also focused on operations as we staffed to meet the workload and moved staff in office settings with no patient contact to work remotely. The supply chain operations have also transitioned from working primarily with a GPO (Group Purchasing Organization) to negotiating directly with global distributors and manufacturers to ensure appropriate levels of supplies and Personal Protective Equipment (PPE) for our patients and staff.
Dana Hendricks, ProAssurance
Our IT department rose to the challenge of setting up nearly 1,000 employees to work remotely. We ultimately expect to return to primarily office-based operations, but the degree to which we were able to adapt was reassuring as we build more telework flexibility into our plans. We are also remotely providing more services to insureds such as risk management evaluations and seminars and sharing COVID-19 and Returning to Practice resources anyone can access at ProAssurance.com.
Adam Kempf, Norton Healthcare
While some business operations have returned to pre-COVID-19 processes, some changes will likely become standard practices going forward, and for good reason. Working from home for certain positions, drive-thru services for select tests and diagnostic procedures, and virtual visits will continue. Using technology differently in healthcare can benefit staff and patients. For instance, we treat patients from across the commonwealth and southern Indiana. With telehealth and virtual visits, we often can provide care for our patients in a way that is safer and more convenient for them.
Steve Oreskovich, Waystar
Our team quickly shifted to 100 percent remote in mid-March. As a multi-locational, cloud-based technology company, our business systems and infrastructure were already configured to effectively allow our team members to successfully function at a high level in a distributed setting. Further, our team members were already used to video conferencing and working across locations, so we were able to make the transition seamlessly. Our leadership team is engaged in thinking through our collaboration model going forward, as we do believe that working together in person in some capacity is essential, particularly as a software provider.
Dana Royse, New Vista
We have a large number of staff working remotely. In addition, we have modified many workflows and communications that are more remote and technology friendly. One small but very impactful change was with our new client paperwork. We realized quickly that completing paperwork online meant we had to make the process simpler. We have looked at every process with a new lens for increasing efficiencies and streamlining processes.
Sharon Tankersley, Hosparus Health
Our care providers have always seen patients wherever they call home, but we needed to leverage use of technology to adapt quickly to video meetings, telehealth visits and other virtual means of communication. Most of our support teams already had the necessary equipment and had trialed a remote work option, so we were able to pivot to close our offices with three days’ notice. Everyone adapted to the new routine of video meetings and phone calls.
MN: How will your organization learn from this pandemic to adjust business strategy and prepare for the next unforeseen crisis?
Craig Collins, UK HealthCare
We have learned a lot from this pandemic and the challenges it has presented. One adaptation is the expedited rollout of telemedicine efforts. Our timeline was drastically slashed compared to an initial plan that called for implementation to occur across 18 months. This knowledge and capability will be ingrained in our strategic planning processes as we evaluate efficient and effective care throughout the commonwealth of Kentucky.
Dana Hendricks, ProAssurance
The goal for ProAssurance is to understand how a crisis (such as a pandemic) affects our customers and then to reposition our operation to support our customers throughout that crisis. The ProAssurance mission statement is “We Exist to Protect Others” and while we hope there is NOT another such crisis, it is another opportunity to demonstrate that our mission is a reality and not just a statement. Further, the incredible work done by our HR and IT departments to organize each stage of our internal reaction to the pandemic (conversion to work-from-home, sanitation of the office during continued critical on-site functions, and the staggered return to on-site work) has built a roadmap that will facilitate an even faster response should any such event occur again.
Adam Kempf, Norton Healthcare
The ability to quickly mobilize our centralized clinical command center was critical to efficient and rapid decision-making and coordination of process changes among all our practices and hospitals. The investment we made in our employees, through our employee help line, paid furloughs, keeping salaries whole, and even providing free meals, was well worth doing. Norton Healthcare also was able to aid Gov. Beshear by staffing the Kentucky COVID-19 Hotline, Norton Children’s COVID-19 Help Line and a long-term care facility hotline. We will be able to use these models going forward and will continue to provide our expertise and resources when coordinating efforts with city and state governments and our community partners.
Steve Oglesby, Baptist Health
The COVID-19 pandemic has allowed us to test the plans we already had in place. We continue to learn from the current crisis and integrate that knowledge into our plans so we can more effectively and quickly adjust care for patients that require unique models of care. We are also reviewing our future strategic plans in light of the fact that moving forward we believe more patients will be seeking various modes of virtual care and we will be making constant developments and changes to ensure we provide the right care when, where and how people want it.
Steve Oreskovich, Waystar
We quickly pivoted to leverage digital engagement to maintain strong customer relationships as well as build new ones. It is really all about understanding what our clients are going through and shifting our focus toward what they need. For example, at the onset of the pandemic, several of our functions began working collaboratively to build a comprehensive COVID-19 resource center, which houses helpful information about telehealth, coding and regulatory updates, emergency waivers, customer inquiry response times and more. We have also launched a free COVID-19 webinar series that focuses on suggestions and requests coming directly from our clients. We believe much of that success stems from the fact that we are choosing subject matter based on suggestions and requests from clients. We have always been listening, but this crisis has been a crash course in active listening and moving quickly to create resources that reflect real-time client needs.
Dana Royse, New Vista
At New Vista, and I am sure other behavioral health service providers, we have lots of staff who are trained in assisting those in crisis. Albeit we are generally resolving an individual crisis and COVID-19 is a widespread pandemic. Nonetheless, our staff are individuals who we can count on; they are the ones we want on our team as we respond to the next unforeseen crisis. As I look back on the first days in March when this situation was unfolding through today. One thing that has been a constant and held our team together is communication. We may not have always had an answer, our plans may change a little from one day until the next, but we were transparent with our message and unwavering in our support of our staff to deliver the best care to our clients no matter what the challenges.
Sharon Tankersley, Hosparus Health
We have learned the value of remote work and the possibilities it offers to improve productivity and flexible work options for our staff. We have been able to leverage telehealth as a value-added means to deliver care as well as an opportunity to provide additional support to families as they care for their family members. It has also been a great opportunity to improve our internal communication efforts, trialing new media and choosing greater transparency in our messaging.
MN: What has been your organization’s greatest accomplishment during the pandemic?
Craig Collins, UK HealthCare
Our greatest accomplishment during the pandemic is the way the entire UKHC team has rallied to support and address the emerging needs of the commonwealth. It truly was all hands-on deck. Everyone stepped forward and everyone made sacrifices to ensure collaborative solutions. We implemented major changes and altered processes in compressed timelines, with “can-do” attitudes. I am proud of our entire UKHC team and thankful for their overwhelming commitment to overcome our COVID-19 adversity.
Dana Hendricks, ProAssurance
The rapid adaption to changes over the first stage of the pandemic was a challenge, and I am proud of how the employees of ProAssurance rose to it. We anticipated and prepared for extreme circumstances from a claims and risk management perspective that, thankfully, did not come to pass at scale in healthcare, such as the use of field hospitals, or the heartbreaking ventilator triage decisions we saw in Italy. However, there were still plenty of surprises at a national scale, such as the drop-off in non-COVID-19 medical care, the subsequent lack of revenue for healthcare practices, and its effects on our customers in Kentucky and throughout the U.S.
When you are a national company, you have 50 different regulators—the state departments of insurance—all issuing different orders on a variety of issues that affect you and your agents. Then you have 50 different state departments of health regulating your customers, which also need to be understood, plus 50 Governors’ executive orders, plus federal agencies such as the CDC and OSHA—it’s a lot to keep track of. I want to thank and congratulate our staff, particularly in the underwriting, service and compliance departments for helping our customers through this first stage.
Adam Kempf, Norton Healthcare
Transparency with our employees and community was paramount from the beginning of this crisis. There were many uncertainties and conflicting pieces of information in the news that created fears, not only clinically, but financially. For 75 consecutive days, our CEO produced a daily video that communicated our current infection rates, hospitalizations, treatment protocols, policy changes, etc., with employees. In addition, we openly shared with our team members the financial losses we were incurring; however, we were clear from the beginning that no employees would be laid off or have their pay cut. Our commitment to the safety and well-being of our staff and patients will always remain our top priority.
Steve Oglesby, Baptist Health
First and foremost is the amazing skill and dedication exhibited everyday by our front-line staff, including physicians and nurses, has been the most remarkable part of this pandemic. In addition, the expertise of Baptist Health clinical informatics and technology teams allowed Baptist Health to quickly develop and implement scalable virtual care and remote patient monitoring (caring for patients at home, including those with mild COVID-19 symptoms). These programs have been a huge success. From an community outreach perspective, Baptist Health worked closely with the Center for Health and Family Services (CHFS) in helping manage the nursing home and post-acute care setting emergencies that became a focal point of the COVID-19 crisis, and we continue to serve as the potential source of the most likely surge of patients.
Steve Oreskovich, Waystar
We are proud that our team across the board has remained focused on our customers. Delivering exceptional client support has always been a core tenet of ours, and we have doubled down on that commitment during the COVID-19 pandemic. Our clients depend on the Waystar platform—and our revenue cycle expertise—to keep their day-to-day operations running smoothly, and we have been able to maintain our high standards of client support even in these difficult times. In fact, our customer satisfaction score has remained high and our average hold time is less than ten seconds. With cutting-edge security measures in place, we have also been able to maintain the same level of network and data security even as our users and our own teams pivoted to a remote work environment.
Dana Royse, New Vista
Our greatest accomplishment has been the ability to continue providing the high quality, evidence-based care for our clients throughout the pandemic. In some locations that has been with telehealth, but in other programs like our residential substance use treatment we have continued to provide in-person 24/7 care while keeping our clients safe. In 20 years with New Vista, I have never been prouder of our team; it has been truly overwhelming to see the dedication our staff have to serving clients in the safest possible way.
Sharon Tankersley, Hosparus Health
I am proud of how every employee and leader pulled together with the attitude that “we will do whatever it takes” to continue providing quality care and services to patients and families. One of our values is “service excellence,” and I think we have seen that demonstrated across the organization.
