A Look Back at a Year for the Books
By Heidi Rose Bender, MBA
In Summer 2019 I was asked if I would be interested in writing an article in late 2020 about reflections on 2020.
Were business goals achieved? Which analytics does my company use as a scorecard for performance? I am a big believer in planning and using metrics to set goals and monitor performance, so I jumped at the opportunity to write the article, and then, of course, 2020 happened. The physical therapy world, much like the rest of the world, was changed in ways nobody could have possibly forecasted when planning for 2020. No one factors a pandemic into their business goals for the year! So, the goals that MRS Physical Therapy started out with at the beginning of the year rapidly changed in March 2020 and continue to evolve to this day.
As a small physical therapy company with nine clinics, we develop goals, budgets, and marketing plans for each clinic at the beginning of each year. Key performance indicators (KPIs) that we use as a guide include visits per new patient, procedures per visit, procedures per clinical hour, revenue per clinical hour, visits per clinical hour, visits per total hour, arrival rate, cost per visit, revenue per visit, and net income percentage. Budgets and goals are then reviewed and potentially adjusted on a monthly and quarterly basis.
In the first few months of the year, the majority of MRS clinics were meeting their metrics. Budgets appeared to be on track and marketing plans were in full swing. Mid-March brought an unprecedented change in business. As the government sought to flatten the curve of coronavirus by encouraging U.S. citizens to stay home, our clinics were faced with a whole new set of challenges.
As patients heeded government warnings, referrals, visits, and billed charges decreased by 40% to 60% across all clinics by the end of March. Marketing plans were brought to a swift halt as physician visits, health fairs, and community events were canceled or postponed. In addition, the government was issuing new and sometimes conflicting directives on PPE, sanitization, and quarantine protocols on a daily, and sometimes hourly, basis. The goals for MRS changed seemingly overnight. Procedures per clinical hour, arrival rate, and net income percentage faded into the background as we began to focus on the ability of the company as whole to meet each new and unparalleled challenge.
The first step MRS took in March was to convene a management “war room” where research, ideas, and news were shared on a daily basis in order to formulate the strongest response to the growing pandemic. We developed two simple yet critical daily snapshot tracking reports. One measured visits (both telehealth and in-clinic), referrals, and cancellations. The other outlined accounts receivable, bank balances, and billed-charges for each office. Our primary goals became two-fold: ensuring patient and employee safety and ensuring each office was operating at a minimum of break-even in order to be able to weather the storm.
The goal of ensuring patient and employee safety was a challenge early on and remains a challenge today. Masks, gloves, sanitization supplies, and thermometers were scarce, particularly in late March and early April and this scarcity of supplies required MRS to get inventive. Employees and their family members sewed cloth masks for employees and patients. MRS purchased facemasks (Buffs) for all employees. Creativity became the name of the game. Eventually we solidified a safety policy that included masks for employees and patients; temperature checks for employees and patients; increased cleaning and sanitization; removal of common items such as pens, magazines, and nondisposable cups; and 14-day quarantines for any patient or employee who travels to a hotspot.
The goal of ensuring each clinic was operating at the minimum level of breakeven, despite a significant reduction in referrals and visits, was equally a challenge. The Paycheck Protection Program (PPP) was vital to helping us survive such a difficult time. However, navigating the application process for the PPP was not easy. We applied as soon as our bank’s online application went live. However, the government was not prepared for the influx of applications and neither was our bank. So we did not receive a loan in the first round. However, through perseverance, we did receive one in the second round.
In addition, the implementation of telehealth was critical to maintaining breakeven as it provided an additional income stream to supplement decreasing in-clinic visits. As soon as insurances allowed telehealth and/or e-visits, MRS began offering them. We refined our process along the way, as needed. Staying connected with our patients was crucial and telehealth was the primary way we kept contact with patients who did not feel comfortable coming into the clinic. At various points during the pandemic, some of our clinics were seeing 30% of their visits via telehealth.
The next challenge was marketing. Maintaining patient relationships, community relationships, and physician relationships, when many traditional marketing channels were shut down, required creativity. We turned to social media, faxing, telephone calls, emails, and patient relationship management software to stay engaged. Our marketing focus shifted to ensure patients and physicians knew we were open and we were taking every precaution possible to keep patients and staff safe. We called and faxed physician offices to let them know we were open and would be happy to assist them in any way possible, as physician offices were over-run with diagnosing and treating potential coronavirus cases. For the fourth of July, we emailed patients information on how to celebrate safely. We also sent patients an email campaign encouraging direct access.
The key to all of the challenges that MRS Physical Therapy faced during the pandemic was the flexibility and dedication of our employees. We developed strategies and plans in the “war room” while our employees carried them out on the front lines. From making masks to learning how to complete a telehealth visit and working with a sometimes skeleton crew, our employees rose to the occasion. By July, a new normal had taken root in our company. Referrals, visits, and billed-charges, which had decreased by as much as 60% at the beginning of the pandemic, began steadily climbing. In fact, most clinics were exceeding their original 2020 goals by mid-July. So, what lessons did I learn in 2020?
First and foremost, I learned that the ability to adapt and evolve in a rapidly changing environment is more critical to survival, and eventually to success, than any metric. When the game changes like it did in 2020, you have to throw out the playbook and change with the game.
Heidi Bender, MBA, is a PPS Administrator’s Council member and vice president of operations of MRS Physical Therapy. She can be reached at h.bender@mrsphysicaltherapy.com.