Moving Forward: Operating During the Pandemic
September 2020 Issue
Step inside an O&P practice these days and it will look and feel much different than it did at the beginning of the year. In the era of COVID-19, experts say the changes meant to keep patients and employees safe have impacted every part of the O&P business.
The changes mean patients are spread out through the waiting room—if they are allowed in the waiting room at all. Every little thing, from pens to television remote controls, has to be closely monitored and either removed or continuously sanitized. Faces are hidden behind masks, and patients and employees alike seem to be more on edge than they were six months ago, our experts say.
Even simple interactions with patients are more complicated now than they were before. Smiles and other facial expressions are tough to interpret behind masks. High fives and handshakes are no longer allowed, says Ken Cornell, CO, FAAOP, owner and vice president of Cornell Orthotics and Prosthetics, headquartered in Beverly, Massachusetts.
"All of that stuff is out the window now," Cornell says. "It does take something away. Whether it's significant, that's a different issue, but there is something lost."
O&P practitioners say they are following guidelines from the Centers for Disease Control and Prevention (CDC). Some of those suggestions include:
- Placing visual alerts, such as signs and posters, for hand hygiene and instructing patients who may have symptoms to return to their vehicles and call in
- Maintaining physical distance as much as possible by increasing workstation spacing and reducing the number of individuals allowed in common areas, like waiting rooms
- Requiring face masks and having them available for any patient who has not brought one
However, the experts say, the guidelines don't have instructions for everything they do. Many practices have also had to adapt and adopt their own safety protocols that work for their offices and patients.
With no pandemic experience to borrow from, the experts say they are figuring it all out as they go.
"There are no protocols to follow, so we're doing the best we can," Cornell says.
Focus on Safety
Experts agree that safety, for patients and staff, should be the paramount concern during this time.
"From day one we read over the CDC guidelines; we made sure we put the health of our patients and colleagues first," says Jimmy Colson, CO, CEO of POP Prosthetics, headquartered in Las Vegas.
He estimates his practice is spending an extra $6,000 to $8,000 per month to cover the cost of staying in business during a pandemic. This includes having a cleaning crew come in five days a week when it used to come in every other day. The number of patients once seen has also been reduced a bit as some of the staff's time is spent sanitizing rooms between patients and half of the chairs in the waiting room have been removed to spread out the people sitting there. Other costs have been incurred as well, including keeping extra masks with the company logo available in case a patient forgets one. Additionally, if an employee tests positive, and so far two have, he or she is paid to stay home until being cleared to return.
Colson says having an accepting and open-door policy makes employees feel more comfortable at work and more willing to come forward if they feel sick. Colson says the last thing he wants is for an employee to hide COVID-19 symptoms out of fear of being sent home and losing pay.
Practitioners say they also fear for the patients who, because of the nature of O&P, are more likely to be at high risk of contracting the virus and becoming very sick.
"I consider all of my patients at risk because my patient population is geriatric patients," says Rick Ramos, CP, LP, president of Premier Prosthetics, headquartered in San Antonio. "Maybe 80 percent of those are diabetic, and a large percentage are also overweight."
At Premier Prosthetics, the office is currently closed to patients on Mondays and Fridays to minimize staff exposure and allow additional time for cleaning. Patients there have to check in by phone when they arrive and wait in their cars until an exam room is ready. In the past, patient rooms were stocked with common tools used for exams, but now the practitioners are in charge of carrying the tools they need from room to room and sanitizing them in between patients, Ramos says.
Even with these precautions, Ramos says he has a backup plan in case any of his staff becomes infected and quarantined. When the pandemic first hit, he sent an administrator and one practitioner who also does marketing and compliance to work from home. These employees work exclusively from home and could come in and work if the rest of the employees are quarantined, he says.
"It would be a skeleton crew, but God forbid if the whole staff had to quarantine, we would still be operational," he says.
Many of these new cleaning protocols are also being balanced with an uptick in patients in some offices. While most O&P practices slowed down considerably during the first few months of the virus, many have reported a surge in patients. Some of those patients feel more comfortable going out, while others came in out of necessity, says Matthew Harris, CPO, Horizon Prosthetics, headquartered in Colorado Springs, Colorado.
"July exploded with patients," says Harris. "We had a lot of patients who wanted to put off coming in until after COVID. We're seeing a lot of people who tried to put if off as long as they could, and they just couldn't put it off anymore. Eventually they decided to risk it and come in, and thankfully, no one has gotten sick."
Changing for the Better
While dealing with COVID-19 has certainly not been easy, Cornell says there have been some bright spots as employees in his office have figured out new and better ways to do their jobs. Cornell has become particularly fond of videoconferencing.
His business runs three full-time offices and three satellite offices, so getting all the practitioners in a room had been a challenge before COVID-19 and was impossible once the pandemic hit. With videoconferencing, it's easy to get everyone together to talk without having to worry about virus exposure or a commute.
"There are some changes we'll keep after COVID," Cornell says. "Our billing staff has started working from home and there's really no reason for them to come back." He says the weekly business meetings over Zoom are effective and efficient.
"We can do so many things remote that we had never done before," he says. "We've found we can work very well remotely."
To help reduce the amount of people in an exam room, he has also started doing virtual appointments with physicians. The patient comes into the office and the physician can watch to see the patient's gait and see Cornell perform all the objective tests, such as manual muscle testing, range of motion, and sensory testing.
Even patients are joining in, Cornell says. If one of them has an issue that does not have to be addressed in-person, they can set up a quick Zoom call to discuss.
"Before, a patient might call and say a piece was broken, we'd order it, and then find out it wasn't the right piece," he says. "Now we can jump on a Zoom call and talk face-to-face, and it takes the guesswork out of it."
A Path Forward
Practitioners say they are focused on keeping their doors open and are willing to do whatever is necessary to serve their patients in a safe setting. With no exact guidelines, many say they feel they are creating the path forward at the same time they are walking along it.
Colson says with his focus on patients and employees, he feels good about the steps his practice has taken. However, he's more than willing to change or improve if need be. "If there's something I can do better, I'd love to know," he says. "I'm always open for constructive criticism and advice."
Ramos says he's learned that changes can come at any time and the best he can do is to try to prepare for those changes.
"You can't take anything for granted," he says. "You have to be prepared, especially financially because it just doesn't affect one owner and one family. It affects everyone—our staff and our patients. We've heard about pandemics like this, but we never really thought it would happen."
Colson agrees. "Who would have thought we'd see this in our lifetime?"
Maria St. Louis-Sanchez can be contacted at firstname.lastname@example.org.