Quarantine life of a premium surgeon
Surgeries and in-person encounters have been replaced with loan applications and telehealth visits.
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Once upon a time, just 4 months ago, I was enjoying banter with my colleagues and industry leaders and celebrating life amid the ocean breeze at Hawaiian Eye 2020 in Koloa. Fast forward, I was sipping on a glass of wine during a Zoom Passover seder hosted by Audrey Rostov and her family over the “11th plague” that has now hit us globally — the COVID-19 pandemic.
Much has happened to everyone, not just premium surgeons, during this crazy time since SARS-CoV-2 assaulted the world. On March 16, I did not expect that early-morning flight home from visiting a colleague to evaluate their EMR system would be my last until at least the fourth quarter later this year. My surgery center canceled all my cataract surgery cases scheduled for the next day, and it was my painful decision to close the office and furlough all my hourly employees ahead of a mandated “quarantine” by our Illinois governor. Below I share my diary of events that transpired to save my private practice and keep my mental sanity during what we all have become accustomed to as “quarantine life.”
Financial loan madness
With suddenly no new income coming into the practice other than that billed on prior surgeries, attention was directed to ways to get financial assistance. A multitude of federal loan options became available fairly quickly, including the Economic Injury Disaster Loan (EIDL) and Paycheck Protection Program (PPP).
EIDL is a Small Business Administration loan, applied for online, that can be used for payroll, fixed debts, accounts payable and other expenses that cannot be paid because of the disaster’s impact. EIDL can be up to $2 million with a 3.75% APR with up to 30 years to repay but is 0% eligible for forgiveness except for the initial $10,000 amount made available within 3 business days of the loan being granted to the practice. The question remains whether this loan can be rolled into the PPP loan for forgiveness.
The PPP loan is part of a $350 billion federal program for small businesses with fewer than 500 employees and must be applied for through any bank/lender approved in this process. Communication between the government and lenders added to the mayhem, but eventually my bank’s online portal made it a fairly easy application process. The PPP must be used for payroll expenses, payroll salaries, mortgage interest, rent and utilities, and interest on debt incurred before Feb. 15, 2020. The amount of the loan is based on 2.5 times the practice’s average monthly payroll based on 2019 numbers, with a $10 million maximum allowed. The loan rate, if not forgiven, is 4% APR with a 10-year term, with deferred payment terms for the first 6 to 12 months. This loan is up to 100% forgiven as long as all employees are retained and rehired by June 30, 2020, with no more than a 25% drop in full payroll costs from the pre-furlough period.
The big surprise, in which the Easter Bunny actually came early for most premium surgeon practices, was the automatic deposit of money into our business accounts on Good Friday, equating to about 6.19% of my practice’s 2019 pure Medicare billings/payments. This much-needed love came as part of the CARES Act, which most experts did not see coming when it was approved by Congress. A second distribution may happen for Medicare Advantage billings from 2019, as well. In Illinois, my practice also applied for the state’s Department of Commerce and Economic Opportunity loan for small businesses in counties outside of Chicago’s Cook County.
Telemedicine adaptation
In March, CMS broadened access for telehealth services to be provided when the patient is in their home. Our practice quickly adopted the new rules so we could provide telehealth to a subset of our patients and had our first successful week of these type of visits. The codes we have adopted include the evaluation and management codes CPT 99201 to 99215, performed through a HIPAA-compliant secure portal. We chose doxy.me, but many others exist, such as Doximity, Modernizing Medicine and EyecareLive. Doxy.me is free but upgradeable for a nominal fee with additional features such as texting and administrative management advantages. Patients have found this process quite easy, especially when most of my visits have been with patients not in the tech-savvy age range.
Real-time audio and visual face-to-face encounters, which do not have to be time-based with E&M codes, are billed. Modifier 95 needs to be used, and place of service 11 should be utilized. Information on the visit, history, review of systems, consultative notes or data used to make a medical decision about the patient should be documented in the patient’s chart. The method of telehealth, including the location of both the patient and provider, should also be documented. I have used virtual check-in codes G2012 (phone call only) and G2010 (patient photo reviewed) for established patients only when doxy.me could not be used by the patient. For either process, written and/or verbal consent for the telehealth visit must be obtained and documented in the patient’s chart.
Personal sanity
The final part of my quarantine life has been keeping my personal health, both physical and mental, in good shape by exercising daily, eating healthy, learning how to become a chef and performing daily projects between everything else already discussed. Recently, I participated in a video named Covid Paradise, created by Paul Singh and Gary Wörtz, along with my fellow CEDARS/ASPENS colleagues. EyePoint Pharmaceuticals also created a fun video with its consultants, in which I have become famous for my kitchen pantry cleansing.
A closing message to all my premium surgeon and industry friends: Stay safe and healthy, Godspeed, and despite the craze of quarantine life, I look forward to celebrating life with all of you in person sooner rather than later
- For more information:
- Mitchell A. Jackson, MD, can be reached at Jacksoneye, 300 N. Milwaukee Ave., Suite L, Lake Villa, IL 60046; email: mjlaserdoc@msn.com.
Disclosure: Jackson reports he is a consultant for EyePoint Pharmaceuticals.
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