Strategies to rebuild patient volumes in the wake of COVID-19

Like many physicians nationwide, Kansas-based primary care physician Jennifer Bacani McKenney saw a dramatic drop in patient volume when COVID-19 hit. A few weeks into the pandemic, McKenney knew she had to take action to keep the practice afloat.

“We decided to go back six months in our schedule to see if there were people we would normally see for regular visits like a monthly weight-loss check or a three-month diabetic check,” she says. “We called them and scheduled appointments either in the clinic, in the parking lot, through telehealth or by phone.”

Soon after, they began calling patients from lists their Accountable Care Organization sends throughout the year, including patients due for well visits and patients with chronic medical conditions who hadn’t yet been seen this calendar year. McKenney’s hope was to get them back on track for visits and let them know it was safe to come in.

Although patient volumes started to increase in early May when Kansas reopened its economy, McKenney says volumes are still down 50%.

This sustained dip in volume is not uncommon. The number of visits to ambulatory clinics declined nearly 60% by early April and is still about one-third lower than before the pandemic, according to a recent data analysis conducted by researchers at Harvard University and Phreesia, a health care technology company.

Only 31% of patients feel comfortable visiting their doctor’s office, according to a recent national survey conducted by Leede Research. Although patients increasingly embrace telehealth, 41% have delayed health care services and 38% intend to delay future care, treatment and procedures.

Rebuilding patient volumes will be a struggle for some practices, says Laurie Morgan, a practice management consultant and partner at Capko & Morgan in San Francisco. “The urgent messages patients have gotten for months about staying home and away from others may seem incongruent with long-standing advice about preventive care,” says Morgan. “Recognizing this hesitancy is, I think, critical to successfully nudging patients to resume care.”

1 Focus on patient outreach

Cheryl Mongillo, MBA, administrative director of two independent family practices in Delaware, says her staff calls patients who are due for a well visit, blood pressure check or hemoglobin A1c test to let them know the practice is open and booking appointments.

“We want patients to know that we’re here,” she says. “We’ve been here the entire time, and we’re not going to abandon them.”

• It may be helpful to provide front desk staff with scripted language to use when talking with patients, says Owen J. Dahl, MBA, FACHE, LSSMBB, founder of Owen Dahl Consulting in The Woodlands, Texas. He suggests focusing on the following:
• Reason for the call
  (e.g., patient is due for annual physical).
• Specific steps the practice has taken to ensure patient safety.
• Date and time of available appointment.
• What patients can expect when they come into
  the office.

“The more scripting you use — and the more consistent you are with the messaging — the more comfortable patients are going to feel,” he says.

2 Be repetitive

“Patients will need to (hear) reassuring messages — plus messages about the risk of continuing to delay preventive and chronic care — multiple times to get them past their resistance,” says Morgan. “Probably, they will need to hear it many times.”

Social media is an excellent outlet for these types of messages, especially when practices use apps that enable them to schedule posts based on optimal times for engagement, says Morgan.

Office manager Debbie Emmons, CMM, CPC, uses social media to reassure patients at her Kentucky-based primary care practice that it’s safe to come into the office. For example, she posts pictures of providers and staff on Facebook wearing homemade masks donated by the community. “It got the point across that we’re all wearing masks, and this is what you’ll see when you come in,” she says. “We also tell patients that if they don’t have a mask, we’ll provide one.”

Email is another option. “However, email is easily missed in a crowded inbox, so practices shouldn’t be afraid of emailing important updates more than once,” says Morgan.

Practice administrator Catherine Franzetti, MBA, sends a monthly campaign through the patient portal with various COVID-19 updates and reminders to help patients of her New York City-based primary care practice stay informed.

And, notes Morgan, make it personal. “Another communication essential: personal contact. It’s invaluable to have someone from the practice contact patients and let them know their physician is concerned with their well-being. This can even be done by an employee working from home.”

3 Provide convenience

Telemedicine, online booking and use of the patient portal should be part of every practice’s strategy, says Morgan. “This is how practices can shine,” she says. “These are excellent ways to ease patients back into a more regular way of interacting with their physicians.”

4 Offer COVID-19 testing

Franzetti’s practice began offering valid antibody testing in early May, and they now perform as many as 250 tests per week. “After one person gets the test, they usually want their whole family to get tested,” she says, adding that some employers require the antibody test before people can return to work. Once patients are in the office for the antibody test, physicians are able to identify other potential care gaps and services.

Kelly Shackleton, practice manager at an internal medicine practice in central New York, agrees. Her practice performs more than 200 valid antibody tests a week. When patients come in for the test, they see firsthand what safeguards are in place, e.g., separate entrances for healthy vs. sick or symptomatic patients, hand sanitizers at each door and a bountiful supply of personal protective equipment. Shackleton even removed 15 out of 20 chairs in the waiting area so patients don’t congregate. Once a patient arrives for their appointment, a medical assistant immediately brings them into an exam room. “All of this adds another level of reassurance that we’re taking measures to be safe,” she adds.

The CDC recently released new guidelines indicating that antibody tests could have high false positive rates. However, Shackleton says all the patients who have tested positive for COVID-19 also tested positive for the antibody.

5 Think outside the box

To better ensure patient safety at her Kentucky-based practice, Emmons says providers evaluate symptomatic patients inside a camper that one of their physician assistants donated temporarily.

Asymptomatic patients are permitted to enter the practice for their appointments. Upon arrival, a receptionist takes their temperature. Patients also receive a mask donated by the community if their don’t already have their own. Then a medical assistant immediately takes them into an exam room. “It’s like we’ve stepped up to be a five-star resort,” says Emmons. “Our patients are getting that one-on-one special treatment. They also feel better knowing that sick patients aren’t even seen inside the practice.”

6 Establish a chronic care program

“Chronic Care Management (CCM) can be done fairly easily, and it helps maintain relationships with your patients,” says Dahl. If practices don’t have sufficient staff to take this on internally, they can hire an external vendor, he says. Physicians can bill for CCM every 30 days, receiving between $42 and $137, depending on patient complexity and time spent.

7 Educate the public

“It’s time for practices to aggressively work with media outlets to spread the word about the risk of children falling behind on their vaccines,” says Morgan. “There’s momentum to reopen schools in the fall, but kids need to be kept safe not just from COVID-19, but from other diseases that may be much more dangerous for children.”

Dahl agrees, noting that media interviews can be a helpful way for physicians to raise awareness of the importance of preventive and chronic care. These are free opportunities to market the practice.

“Rebuilding patient volumes won’t be like turning on a light switch,” says Dahl. “The expectation is that we need to plan on this taking a period of time.”