Beyond the PPP
While the PPP may have been the most beneficial component of the CARES legislation in allowing small businesses to secure a forgivable loan, there are other programs that can assist private practices. Gavin Setzen, MD, past president of the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) and an otolaryngologist in private practice at Albany ENT & Allergy Services in Albany, N.Y., secured a PPP loan for his practice but also applied separately for the Economic Injury Disaster Loan (EIDL) program, which provides grants up to $10,000 in the form of an immediate advance. Dr. Setzen’s practice has a staff of 115, including 10 otolaryngologists, eight physician assistants, seven audiologists, a CT technologist, a speech-language pathologist, and an allergy testing and immunotherapy department. At the time of this reporting, they were closed to non-urgent in-person patient visits but were providing telehealth services. EIDL funds, he said, can be used to meet working capital needs other than payroll. The practice also requested debt forbearance (an agreement between a lender and a borrower to temporarily suspend debt payments) for 90 days. The forbearance amount will be added to the term of the mortgage on the practice’s new 54,000-square-foot office building and ambulatory surgery center, which Dr. Setzen said has been very helpful from a cash flow perspective.
Explore This IssueJune 2020
Other ways to maintain cash flow, according to Dr. Setzen, include candidly discussing the practice’s financial situation with landlords, billing services, vendors, IT support, and others, as well as contacting malpractice insurance companies. In New York, he said, malpractice premium payments were suspended for 60 days if the practice was not providing more than 20 hours of care per week. For some practices, it may be worth considering temporarily transitioning to part-time status.
“Also, file a claim with your business interruption insurance carrier,” he said. “It will likely be denied, but the claim is on file and there is pressure to have this [COVID-19] considered a covered event.”
Predicting the Future
Dr. Setzen believes that as many of the surgical procedures performed in otolaryngology are minimally invasive, outpatient, or office-based, patient concerns about disease transmission will have a significant impact for the foreseeable future on the performance of these mostly elective surgical procedures.
“I think until there’s adequate diagnostic testing, serology demonstrating immunity, herd immunity, and a reliable, readily available vaccination, there will still be hesitation amongst patients and otolaryngologists alike when diagnosing and treating conditions where viral load transmission and potential for a realization of particles exists,” he said.