Nothing helps to crystallize the need for contingency planning for a cosmetic dermatology — or any other kind of dermatology — practice like a few hurricanes. Much to my dismay, I became intimately acquainted with Charley, Frances, Jeanne and almost Ivan this past hurricane season and became well-versed in creating a solid plan “B” to avoid the potential obliteration of my busy cosmetic dermatology practice in West Palm Beach — close to where three of the four hurricanes landed. As Jimmy Buffett says, “there is no way to reason with hurricane season” but there are a few things you and your staff should do to insure continuity of practice in the event of an interruption in business. The Number-One Concern The first and foremost thing to consider is the preservation of the safety of yourself, your staff and your patients. In the event of an unforeseen problem, you won’t have time to consider policies and procedures needed to protect these people. So spend some time figuring out an office evacuation plan. Practice it often, more frequently if you have a large facility with a lot of staff. My office employs a certified risk manager who has implemented and rehearsed such scenarios. She has even posted little envelopes by each workstation spelling out emergency procedures for every person. (One hint: if you are inspected by the fire marshal, do not replace the risk manager’s notes with “run like hell” — they sometimes do not find this amusing). Securing Office Operations The next most important consideration is data preservation. I have, without a doubt, the best computer person in the U.S.A. (Ramsey Bouhadir). He has created backups for every aspect of our office including billing records, patient photos and all of our other data. In addition, he ensures that the backups are actually backing up. When the hurricane was bearing down on us, Ramsey came to our office and took apart our network with great care and moved it to a place where it was least likely to be adversely affected by the storm. He also made sure that duplicate data tapes and hard drive images were dispersed so that loss of any one would not cripple the office. We run GE Centricity software for practice management, and one great benefit is the ability for GE to run our office remotely. Fearing the loss or severe damage to the structure in which we practice, I called Tom Maxwell at GE and discussed the worst-case scenario. He assured me that GE could operate the scheduling and billing remotely. This was very comforting to hear prior to the hurricane. Other things to think about regarding office operations include making a written policy delineating what needs to occur prior to an emergency office closure. The first hurricane that caused us to evacuate was followed by several days without phone service, but my employees and myself were at the office waiting to see patients. Unfortunately, the patients didn’t know this because we didn’t leave any message on our answering service (which, since it runs remotely by our telephone provider continued to work despite our lack of phone service). For the second hurricane evacuation, we learned from the experience and left a message declaring our intention of seeing patients on the Monday following the event. The transition back to business was much smoother as a result of this, and I think it was easier for patients, staff and physicians to assume a normal life as rapidly as possible. Ensuring That Proper Supplies Are On Hand Prior to the hurricane, we’d ordered about 100 vials of Botox and about 50 syringes of Restylane. This actually became an issue when we were forced to evacuate because we needed to ensure that these products remained viable. We were able to store the Botox on dry ice in a 5-day cooler. The Restylane and other fillers that needed to be stored at room temperature were placed in waterproof coolers to maintain temperature and moisture stability. We left the collagen products in a refrigerator that we connected to an in-office generator. The products all did fine, and I’m glad that we considered what we would do with our $100,000 of inventory beforehand. Up-to-Par Paperwork Paperwork is also important in the event of an evacuation, and you should put a few things on your to-do list in case you need to leave. Items to consider include the following: • Accounts receivable. Print a list of your accounts receivable — you may not have the opportunity to generate revenue for a while, and it will be your only source of income. • Next month’s schedule. Print a schedule for the next month in duplicate. That way, if you need to contact your patients, you have a ready way to do so and will know in what order they need to be contacted. • Pathology results. If you keep a log of pathology results, this is something to take with you, if possible. • Insurance policies. You should also take a copy of your insurance policies. Insurance policies need to be evaluated annually. Once the hurricane was upon us, I realized that I didn’t have business interruption insurance. I also realized that since the time I’d purchased the insurance, I’d added hundreds of thousands of dollars of improvements and products to my practice, and these changes weren’t included in my policies. When my insurance agent visited, he focused on his trying to sell me life insurance annuities instead of focusing on my needs. But instead of switching brokers, I acted like many physicians and delegated this critical aspect of the office. I would urge you to spend time evaluating your needs and comparing policies. If you don’t, learning the hard way could have significant costs. Real Eye-Opener After hurricane season had wreaked its havoc, the worst of what we faced caused some challenging moments. At one point, we didn’t have phone service for a week, and my nurses were calling patients from their cell phones. Roads were impassible for several days and there was no gasoline after one of the storms so patients were unable to keep their scheduled appointments for several days. However, throughout this surreal and frightening experience, I learned a valuable lesson — the most important aspect of any unforeseen event is the ability and desire of your staff to function effectively. Any staff member who isn’t interested in helping during a time of crisis or isn’t able to effectively function should be given serious evaluation when the crisis has resolved. Sometimes it takes an emergency to show you how good (or bad) your staff is. Regarding the recent potential crises, I can only say that I was surprised at how rapidly and efficiently my staff pulled together. No one had to be coaxed or pushed to do anything, and everything that needed to get done did in fact get done. I guess that this, more than anything else, was the best thing I learned from the experience. Dr. Beer is in private practice in West Palm Beach, FL. He’s also Clinical Instructor in Dermatology at the University of Miami, a Consulting Associate in the Department of Medicine at Duke University, and Section Chief of Dermatology at Good Samaritan Medical Center in West Palm Beach.
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