Back to Basics - A Series Presented by your PAHCOM National Advisory Board

Part I - Emergency Preparedness
As our nation and the rest of the world are still reeling from the effects of COVID-19, medical office managers are tasked with making sure that our practices are prepared for the next emergency that will undoubtedly occur. This is not a doomsday prediction but, rather, a pragmatic statement about being proactive for the protection of our patient population and maintaining our thriving businesses despite any emergency declarations. In light of any havoc caused by the lack of preparedness for a state of emergency, it is time for all medical managers to consider going back to the basics of medical office management. Throughout the remainder of 2020, your National Advisory Board will produce a series of articles that will help our members build the foundation necessary to sustain their businesses during any state of emergency. In this issue of The PAHCOM Journal, we will look at disaster planning. 

Every medical office should have an actionable disaster plan. This plan should be reviewed by the entire staff at least once a quarter and should include live action exercises so that staff members have a chance to feel comfortable about your practice's plan to succeed during any type of emergency. Your staff should have 24-7 access to your disaster plan and there should be an easily accessible digital copy as well. Some offices have a disaster plan and practice sheltering in place and/or schedule fire drills. That simply is not enough! Disaster plans should contain contingency plans, decision matrices, inventory lists, and appropriate links to local, state, and federal resources. 

It is absolutely essential to have a dedicated funding source in the event of a disaster. COVID-19 and the subsequent quarantine have ravaged the American economy. With millions asked to stay home and millions more reducing our workforce to only essential staff, businesses are losing money each day. Medical practices are also facing the same challenges. For some offices, this quarantine meant closing their doors temporarily while still needing to meet payroll and overhead. One best practice is having a line of credit specifically tied to your business during a state of emergency. The key is to prepare to survive for at least three months with no incoming receivables. Although this may be a "worst-case scenario," planning for the worst is the reason for your disaster plan. Knowing that your practice can meet its financial obligations until resuming "business as usual" allows managers to focus on other pressing issues, such as patient care. 

A cyber-attack or critical power failure can be devastating to any medical practice, especially to those who use EHR exclusively. Accordingly, we must plan for the potential loss of data and, hopefully, the recovery of critical data. Contingency planning will afford your practice the opportunity to secure your data in the event of an emergency. This type of plan means that you have a blueprint for backing up data and an understanding of what your system is capable of during emergency mode operations. Applications and data criticality analysis are essential to ensuring your practice can continue to thrive despite any ongoing emergency. According to CMS, the purpose of the Application & Data Criticality Analysis is to determine the criticality to your practice of all application-based components and the potential losses which may be incurred if these components were not available for a period of time. 

When you can afford staffing and are assured your EHR can store and protect data, be prepared to make some tough decisions about how your practice will move forward during the emergency. Create a decision matrix to determine which positions are essential to your operation. Use the, "Given-When-Then" formula to ascertain how your practice will function during an emergency. For example, GIVEN that most of my patient population are over the age of 50 and have underlying health conditions, they have been quarantined by order of the governor. WHEN they need routine medical care for non-life-threatening illnesses, THEN we will offer tele-health appointments with our providers. Here is another popular example: GIVEN that the number of traditional face to face encounters has sharply decreased; WHEN the number of face to face encounters reaches less than 25%, THEN  I will reduce my front desk staffing to one essential staff member who is cross-trained to assist in other areas of the office.

The realignment of your staffing resources will play a critical part in the success of your practice during an emergency. As healthcare workers, we are, by default, considered essential workers. This does not mean that you will need to keep all of your staffing throughout the entire emergency period. At some point, whether it be due to illness or payroll reasons, the reduction of your workforce should be conducted in a manner that affords your practice the opportunity to thrive. It is advised to keep track of which staff members are cross-trained and what best skill set they offer. As the need to reduce your workforce occurs, retain your strongest workers to power your practice. For example, an administrative assistant who has worked in billing can help send secondaries and contact payers who are taking longer than normal to pay. A medical assistant who has strong administrative skills can help with scribing for your providers who may likely need help with their tele-health notes. Do not wait until an emergency occurs to decide who is next up for a position, get a handle on it now. Ensure that your staff knows who is the second to their position, so that they can cross-train them with purpose.
It is also highly advised to appoint an inventory control officer. This person should have a thorough knowledge of OSHA and Safety Standards and the appropriate Personal Protective Equipment (PPE) that may be needed for use in your office. Your inventory control officer should maintain an acceptable level of PPE at all times (as deemed by your leadership team) and also plan any PPE drills. This officer should also have an account with several vendors to ensure the ability to replenish materials as necessary. It is a good idea to consider adding a local supplier to your vendor list. During the early days of COVID-19, Amazon and Quill were out of stock or rationing many items such as hand sanitizer and procedure masks while local vendors had these items in stock. 

When you refresh your Disaster Plan's Policy and Procedures, remember to write in plain language. Your plan must be easily understood by the entire staff and should include active exercises to reinforce your policy and procedures. Coordinate your disaster plan exercises with your OSHA and safety officers and be sure to make the training fun. 

The Federal Emergency Management Agency (FEMA) has tabletop presentations that cover many types of emergency situations such as cyber-attack, earthquake, critical power failure, hurricanes, and chemical accidents. By using available resources, the training can become entertaining and meaningful. Work with your leadership team to define the goals of your disaster training. If you live in an area prone to tornadoes, then use it as one of your focal points. Once your goals are set, create your learning objectives and infuse as many hands-on trainings as possible. When you methodically organize your training modules you build a stronger foundation. Remember to practice often and re-evaluate your Disaster Plan annually. Take into account that healthcare offices are the backbone of this great nation; we ensure continued health and are there to assist in times of need. Let's make sure we stand ready to live up to the promise to our communities. 

Thank you to your National Advisory Board for this great information. 

Coley Bennett, CMM, CHA
PAHCOM Member Since 2016 

Crystal Burning, CMM
PAHCOM Member Since 2010 

Kathryn Eiler, CMM, HITCM-PP
PAHCOM Member Since 1995

Kim Krause, CMM
PAHCOM Member Since 2004

Look for more "Back to Basics" in the next issue of The PAHCOM Journal