How One Houston Orthopaedic Practice Addressed the Pandemic

Krista Armstrong with State Rep. Tom Oliverson, MD prior to testifying in the 2019 Texas Legislature.

By Krista Armstrong and Joseph Mathews
Advanced Orthopaedics & Sports Medicine

Pandemic. A word that most administrators did not see on a syllabus or discuss in their health administration classes in college. Can someone truly prepare, communicate or plan the right steps when there is no clear path or end in sight? But in 2020, that is where we find ourselves. Waging a war with a virus that has inadvertently attacked not just our productivity and financial viability, but our very views of normal life.

Data, in turn, is a word that administrators know all too well and possibly a light in the shadow of this pandemic – despite the daily barrage of seemingly negative data thrown at us about the virus. While many practices across the country continue to face unsurpassable obstacles and some have been unable to stay open, we want to make sure we share what we have learned about the culture of our practice and how data and sacrifice have made a difference in keeping our doors open.

We are grateful at Advanced Orthopaedics and Sports Medicine (AOSM) that we have not had to close a single day in the midst of the COVID-19 pandemic, but that does not mean that we did not make sacrifices or find ourselves in difficult and very uncomfortable places. Our physicians have spent more time out of the operating room than in it or treating patients via a phone or tablet screen. Our staff have frequently operated within the bullet point of their job description that says “other duties as assigned” and far from the role they may have been hired for. Our patients find themselves wondering if it is safe enough to come in at all, but in so much pain they began to weigh the risks. Our managers search for the right words to say to anxious, worried staff when the balancing act of personal concerns and work duties becomes like walking a tight rope each day. And we all have faced the reality that continuing to do things a certain way simply because we have always done them that way is no longer a viable option for the practice.

Advanced Orthopaedics has always prided ourselves in being data-driven and doing our best to establish and work against benchmarks.  We also have a team of doctors and staff that at its very foundation were willing to do whatever it took to keep things moving. Data and dedication.

When patient volumes began to decrease and elective surgeries were put on hold, we did have to make some permanent personnel cuts, but it was less than 10%. The remaining AOSM staff agreed that if everyone took a little bit then no one would not have to sacrifice it all – not only in their pay, but their duties. We had billing staff, HR managers and even physical therapy techs running front desk. We cross-trained therapy front desk in physician appointments and verifications. Billing staff learned to run in the main operator role. Medical assistants learned check-in and copay collections. Managers literally went wherever they were needed, even if that meant the nearest Dollar Store or Costco to get much needed essential supplies.

Joseph Mathews with Congressman Kevin Brady.

Clinics were consolidated for more efficient staffing and use of supplies. Schedules were constantly assessed to move staff between the departments. We moved products and supplies between locations and put ration protocols into place to cut unnecessary spending.

While we did reduce hourly staff to 32 hours and salaried employees took a 20% pay cut for a brief period, our doctors also took on a heavy burden – taking no paycheck for two months. Managers worked longer hours even with the reduced pay to make sure that new processes including Telemedicine were implemented.  PPP loans and HHS distributions allowed the practice not to have to dip into the line of credit business. Our communication about the practice’s condition was as transparent as possible without raising too much anxiety. We engaged our staff in how their roles and the sacrifices we were asking of them were vital to the long-term health of AOSM.

But, it was still all in the numbers – data and reporting became an even larger part of our daily routine. We balanced quality metrics with appropriate workloads using national benchmarks in everything from physician and therapy patient volumes, appointment call volumes, and claims worked by billing staff. Focus on billing KPIs were essential to maintain a tight revenue cycle. Not only did it give us a chance to see what was happening right now, but a chance to develop appropriate strategies for rebuilding, identifying areas of overstaffing, how to maximize cross training opportunities, and identifying necessary process improvements. So, in the midst of all that has and continues to be shoveled around on the surface, we found our seed – the root that makes our practice strong and what we need to survive long term.

Data and dedication are not just two random words that make a good topic for this article. It is the very foundation that has now been truly tested in a healthcare environment none of us could have anticipated.

While sharing these simple things may seem to dilute how truly complicated it has been to keep our practice afloat, it speaks to how we should be working through problems big and small even after COVID-19. Our goals should be on hiring staff that are of strong character, dedicated, and driven to truly be part of a team – willing to go and do whatever it takes to make it work. Our training should be focused on initial job duties first then branching out to various cross-training opportunities of all employees. Our solutions should be less emotional and reactive and more frequently derived from data, benchmarks and projections. Our culture should be one that thrives on taking ownership of your role in every outcome, creating a spirit of dedication to something bigger than yourself, and using data as our roadmap.