Navigating COVID-19 relief programs
Answers in Practice
By Victoria Houghton, managing editor, June 1, 2020
Dermatology World talked to James Zalla, MD, from Florence, Kentucky, about his efforts to keep his practice afloat during the COVID-19 pandemic. This interview reflects the situation as of April 21.
Dermatology World: Tell us about your practice.
Dr. Zalla: Our single-specialty dermatology group is owned by four dermatologists and assisted by three physician extenders. We have been seriously impacted by the COVID-19 virus. We have 37 full- or part-time staff in addition to our physicians.
Dermatology World: What did your practice do to manage patients during the COVID-19 outbreak?
Dr. Zalla: We restricted live patient visits to those with urgent problems, such as growing skin cancers, to one day a week. We have those patients call when they arrive at the office and wait in their vehicle until an assistant is ready to bring them to an exam room to avoid patient-to-patient interaction in our waiting room. Over 90% of our patient visits have been postponed in keeping with the Kentucky governor’s restrictions to “Stay at Home” except for urgent visits.
Dermatology World: How are you protecting your staff during the pandemic?
Dr. Zalla: Most staff have been off since March 23 because of reduced patient appointments. Some staff acknowledge fear of virus contact and a few others are home with younger children with no daycare available. Our medical assistants, nurses, and other clinical staff have been reduced to four who were willing and able to come in for limited schedules. We were able to obtain N95 masks and had a supply of other surgical masks but have not been able to replenish our supply of hand sanitizer. Patients are screened for fever, travel risks, etc., before they can be seen. We have maintained most of our front office staff hours needed to cancel appointments and beginning to screen patients and schedule for telehealth visits.
For those four clinical staff who have come in to care for live patients in the past two weeks, we have added two dollars per hour to their rate as a “COVID-19 differential.” We have tried to limit their hours to less than their usual number of hours so that they also can apply for partial unemployment and receive the extra $600 per week like their coworkers who remain at home.
Dermatology World: What are you doing to attempt to stay afloat through the pandemic?
Dr. Zalla: Our private carriers in Kentucky and Medicare do cover telehealth visits, but the absence of procedures and pathology revenue will be significant. We have requested and obtained interest-free deferrals on some recurring monthly payments due to various vendors, to help offset the anticipated decreased cash flow.
We have encouraged our staff to apply for partial or full unemployment benefits retroactive to March 23 which will also allow them to receive the additional $600 per week supplement. Because our revenue stream will be seriously reduced, our physicians reduced our normal salary by 50% when we had to reduce appointments. We did not reduce the salary of our extenders, anticipating that with a recovery later in the year they would eventually reach their target of collections, even if they do not reach their usual bonus potential.
Dermatology World: What federal aid programs are you exploring?
Dr. Zalla: We applied for a Paycheck Protection Program (PPP) loan in early April through our bank and ultimately through the SBA and received the loan on April 21. This loan will cover the projected costs of our payroll and rent/utilities and including staff health insurance benefits for eight weeks. If by the end of June, we have kept the same number of full-time equivalents on our payroll as our average month last year, we expect the loan to be forgiven as part of the government plan to support small businesses. There is a 1% minimal interest rate to the bank. Our dermatology group has spent many hours exploring our options with the help of our PEO payroll service, and we recognize it is a leap of faith that all of our staff will be back on board at the end of June. In the meantime, even though we do not have enough work for them to be busy as before, the PPP loan will allow us to support our staff at 100% of their usual pay for eight weeks in May and June. If it takes much longer for a recovery, it is likely some staff will go back on unemployment benefits.
James Zalla, MD, opened Dermatology Associates of Northern Kentucky in Florence, Kentucky, in 1970 and practices with Drs. Mark Zalla, Susan Bushelman, and Molly Grunenwald Eisner. Dr. Zalla is past president of the Kentucky, the Cincinnati, and the Noah Worcester Dermatological Societies and the Boone County Medical Society. He is a past member of the Board of Directors of the American Academy of Dermatology and serves as chair of the Academy’s Practice Operations Committee.
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