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COVID-19

Article 07.14.2020 Dean Dorton

As school districts prepare for the upcoming school year, new risks warrant attention due to the COVID-19 environment. The following list provides insights into the different functional areas of a school district that require a new view. Overall, school districts need to implement controls to properly navigate through this new learning environment. A benefit to these extra efforts will be new lessons learned that can be applied in the post COVID-19 environment in the future to make the school district even stronger.

Once the COVID-19 plans and controls are established, school boards need to hold management accountable for tracking the effectiveness of the collective COVID-19 program. Internal audit represents an effective resource to provide the school board and associated audit committee comfort that the program is designed and operating effectively. Any COVID-19 program deficiencies should be noted timely and remediated in an efficient fashion. The failure to actively monitor the program will enhance the risk of safety, legal, and compliance issues.

Please let us know at Dean Dorton if we can help you establish, monitor, and test these new COVID-19 controls.

Print the PDF Check-list

Risk Area # Risk (Uncertainty) Description Controls in Place (Y/N)
Finance 1 Adequate funds to manage additional required costs such as personal protective equipment (PPE), sanitizer, additional janitorial, additional bus aids, nurses, and other requirements.
2 Tracking of COVID-19 purchases (coding of transactions including payroll) to maximize federal/state reimbursements.
3 Compliance with Redbook and maintaining effective controls for bookkeepers/school-level business processes.
Purchasing 4 Purchase of adequate, timely, and quality PPE.
5 Modification of key purchasing/disbursement controls due to remote work place.
Human Resources 6 Having sufficient teachers and other resources (bus drivers and aids) to meet COVID-19 plan including social distancing.
7 Onboarding and monitoring new employees in a remote environment; integrating culture.
8 Proper training for teachers to teach in a remote environment.
9 Assessing teacher performance in a remote environment.
Operations 10 Protecting at-risk teachers/employees including bus drivers based on underlying risk factors.
11 Implementation of collective COVID-19 action plan including after school programs/sports and how incidents will be communicated.
12 Parents won’t allow children to return to school due to safety concerns.
13 Providing childcare options for employees including use of current facilities.
14 Creating a COVID-19 benchmark report to monitor operations and results of COVID-19 efforts.
15 Meeting food service requirements.
Information Technology 16 Sufficient technology on both ends to support remote learning for all.
17 Expanded virtual meetings, expanded remote working, remote data entry, remote new
employee testing, reliance on e-documents (risk of authenticity), etc. Expands technology/
cyber risks.
18 IT workload has increased substantially. Potential risks for staff burn out and/or being able to maintain consistent level of service.
19 Tracking of expanded technology equipment including mobile devices.
Legal/Compliance 20 Elevated potential litigation/OSHA compliance.

For more information on how the coronavirus is impacting businesses across multiple industries, visit our COVID-19 resource page:

COVID-19 Resources

Filed Under: COVID-19, COVID-19 Business, Cybersecurity, Risk Management, Services Tagged With: COVID-19, school district

Article 06.9.2020 Dean Dorton

As eluded to in our Paycheck Protection Program (PPP or the Program) update last week, President Trump signed the Paycheck Protection Program Flexibility Act (the Flexibility Act or Act) into law on June 5, 2020. The Act provides borrowers of a PPP loan additional time to spend the loan proceeds and reduces the percentage required to be spent on payroll to achieve full forgiveness. Although the Flexibility Act is relatively short, it contains several key changes to the terms of the Program, including loan forgiveness.

Loan Forgiveness

A “new” covered period

One of the most significant changes for borrowers under the Flexibility Act is the expansion of the eight-week period to spend loan proceeds to the earlier of 24 weeks after loan origination or December 31, 2020. Borrowers who received a PPP loan before June 5, 2020, may elect the original eight-week period, if preferred. A key question that accompanies this change is whether the 8/52 limitation on cash compensation paid to an employee with annual compensation over $100,000 will be updated to 24/52 of $100,000. This was not addressed in the Flexibility Act and will likely be clarified through additional guidance from the Department of the Treasury and the Small Business Administration (SBA).

75/25% rule now becomes 60/40%

Another significant change under the Flexibility Act is the revision of the previous rule requiring at least 75% of the loan forgiveness amount sought by borrowers to be comprised of payroll costs, with no more than 25% of this amount consisting of nonpayroll costs (i.e., the 75/25% rule). To allow for greater flexibility in using loan proceeds, the Flexibility Act now requires a borrower seeking forgiveness to use at least 60% of the loan amount for payroll costs and up to 40% for nonpayroll costs. The language of the Flexibility Act, read literally, creates an “all or nothing” threshold in which applications for forgiveness would be denied altogether where borrowers have not spent at least 60% of the loan amount on payroll costs. However, a joint statement issued on June 8, 2020, by U.S. Treasury Secretary Steven T. Mnuchin and SBA Administrator Jovita Carranza provides that the 60/40% rule will be administered to allow for partial loan forgiveness. The joint statement says, “If a borrower uses less than 60 percent of the loan amount for payroll costs during the forgiveness covered period, the borrower will continue to be eligible for partial loan forgiveness, subject to at least 60 percent of the loan forgiveness amount having been used for payroll costs.” (Emphasis added.) Also, in their joint statement, SBA and Treasury said they would promptly issue rules and guidance, a modified borrower application form, and a modified loan forgiveness application implementing the legislative changes from the Flexibility Act.

Extension of time to restore FTEs and salary/wage reductions and new safe harbor exemptions for FTE reductions

Recall that under the CARES Act, a borrower’s forgiveness is reduced if the borrower experiences a decline in full-time equivalent (FTE) employees or reduces certain employee salaries or wages by more than 25% during the eight-week covered period compared to a specified reference period. However, the CARES Act provided a safe harbor under which a borrower’s forgiveness would not be reduced if the borrower restores a reduction in FTEs or employee salaries/wages occurring between February 15 and April 26, 2020 on or before June 30, 2020. The Flexibility Act provides more time for borrowers to satisfy this safe harbor by pushing back the date for restoring FTE employees and salary/wage reductions from June 30, 2020, to December 31, 2020. Also, two additional exemptions from the restoration requirement for FTE employees are now available if borrowers can document either of the following:

  1. An inability to rehire previous individuals that were employees on February 15, 2020, and an inability to hire similarly qualified employees for open positions on or before December 31, 2020; or
  2. An inability to return to the same level of business activity that existed before February 15, 2020, due to compliance with established requirements or guidance (i.e., related to standards for sanitation, social distancing or any other worker or customer safety requirement) issued between March 1 and December 31, 2020, by any of the following:
    • The Secretary of Health and Human Services,
    • The Director of the Centers for Disease Control and Prevention, or
    • The Occupational Safety and Health Administration.

Like all things related to loan forgiveness, documentation is vital. Borrowers should ensure they are retaining adequate documentation to support conclusions concerning any safe harbor exemption as well as inputs to the loan forgiveness application.

Other Changes in the Flexibility Act

Program Term Previously, the CARES Act provided an “end date” for the Program of June 30, 2020, which raised questions about a borrower’s ability to apply for and receive a PPP loan as well as spend loan proceeds after that date. The Flexibility Act has now extended the date to December 31, 2020. However, in a separate statement, Congress made clear that the last date for which a PPP loan application can be approved is June 30, 2020.
Loan Term For PPP loans originating on or after June 5, 2020, the minimum term of the loan is increased to five years. Borrowers who have previously applied for and received a PPP loan will still have a two-year term for repayment of any remaining loan balance after forgiveness. However, borrowers should check with their lender to see if the lender would extend the terms of their loan.
Deferral Period The deferral period for payments of loan principal, interest and fees was modified to now begin on the date that the amount of loan forgiveness is determined and remitted to the lender. However, borrowers who have not applied for loan forgiveness within ten months from the last day of their covered period will begin paying principal, interest, and fees on that date.
Social Security Tax Deferral Borrowers who have received forgiveness of a PPP loan are now eligible to defer payment of the employer’s share of Social Security taxes that would otherwise be required to be paid during the period beginning March 27, 2020 and ending December 31, 2020. The deferred tax liability will be due in two installments: (1) 50% due on December 31, 2021, and (2) remaining 50% due on December 31, 2022.

 

 

For more information on how the Coronavirus is impacting businesses across multiple industries, visit our COVID-19 resource page:

COVID-19 Resources

Filed Under: Accounting & Tax, COVID-19, COVID-19 Business, COVID-19 SBA Loan Programs, COVID-19 Tax Tagged With: Borrowers, COVID-19, Flexibility Act, Forgiveness, Loan Application, PPP Loans, SBA Loans

Article 06.4.2020 Dean Dorton

Forgiveness: The Nitty Gritty

Breaking News – The Senate unanimously passed a bill yesterday evening that proposes to modify key aspects of the Paycheck Protection Program (PPP or the Program) and ultimately aims to provide greater flexibility for borrowers to spend their loan proceeds and subsequently seek forgiveness.  The bill has now been sent to President Trump for signature and, while technical corrections are anticipated to be made, the current version of the bill would amend the following features of the Program:

  • Increases the current two year loan to a minimum of five years for loans made on or after the amendment date becomes effective
  • Extends the end date for use of funds under the Program to December 31, 2020
  • Expands the 8 week covered period to the earlier of December 31, 2020 or 24 weeks after loan origination.  Borrowers may still elect to utilize the current 8 week period, if preferred.
  • Revises the previous 75/25% rule to now be 60/40% related to the use of the loan proceeds between payroll and nonpayroll costs
  • Provides borrowers with an additional exemption to a reduction in full-time equivalent (FTE) employees if they are able to document their inability to hire or re-hire employees or that they were unable to return to the same level of business operations due to compliance requirements established by regulatory agencies
  • Modifies the current six-month deferral period for loan principal and interest payments to now begin on the date that forgiveness of the loan is remitted to the lender (up to a maximum deferral of ten months from the end date of a borrower’s covered period)
  • Allows borrowers who received forgiveness of a PPP loan to now defer the deposit of certain employment taxes under Section 2302 of the CARES Act (previously borrowers who received forgiveness were ineligible)

If the bill is ultimately signed by President Trump, we will provide an overview of the final version of the bill, once available.

This information was last updated on Thursday June 4, 2020 at 11:00 a.m. We will update this page with changes and update the timestamp accordingly.

Before we begin, two quick reminders: (1) this Program remains a work-in-process and information provided is subject to change! (2) for all costs about which the CARES Act and the SBA are silent, there is the possibility that payment of those costs will not be forgiven and will have to be repaid.

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Filed Under: Accounting & Tax, COVID-19, COVID-19 Business, COVID-19 Industries, COVID-19 SBA Loan Programs, COVID-19 Tax, Services, Tax Tagged With: COVID-19, Forgiveness, PPP Loans

Article 05.29.2020 Dean Dorton

  • The latest on loan forgiveness revealed in the Loan Forgiveness Application and Interim Final Rule on Forgiveness
  • How the Loan Forgiveness Application works
  • Strategies for maximizing loan forgiveness
  • Legislative developments related to PPP loans
  • Documentation required for loan forgiveness
  • C-suite executives
  • Controllers/bookkeepers
  • Payroll executives
  • Office managers
  • Anyone who plays a vital role in tracking and spending your PPP loan

Presentation slide deckPPP loan forgiveness guidance

The matters discussed in these materials provide general information only. You should consult with an advisor about your specific situation before undertaking any action because each organization’s situation is unique. This information may not be construed as either accounting or legal advice.

Filed Under: COVID-19, COVID-19 SBA Loan Programs, Services, Tax Tagged With: COVID-19, Webinar

Article 05.21.2020 Dean Dorton

The American Institute of Certified Public Accountants announced earlier this afternoon that the Department of the Treasury would issue guidance no later than Friday, May 22, 2020, answering 25 or more frequently asked questions about loan forgiveness. The information in this article likely will change as a result of those answers. Additionally, bi-partisan, bi-cameral legislation is making its way through Congress and may have a major impact on forgiveness calculations.

We will provide additional guidance and host a webinar on forgiveness early next week. Information on the webinar will soon be available at deandorton.com/events.

Late Friday, May 15, 2020, the Small Business Administration released a Loan Forgiveness Application (Application) for Paycheck Protection Program (PPP) loans. After testimony by Treasury Secretary Steven Mnuchin at a Tuesday, May 19, 2020, hearing of the Senate Banking, Housing, and Urban Affairs Committee, the Application may be the final word on forgiveness. In response to questions from Sen. Kyrsten Sinema, D-Ariz., Mnuchin said, “I thought the guidance we put out dealt with all the issues.” As a result, borrowers need to make the most of guidance they can glean from the Application.

This article focuses on the partial resolution by the Application of four unrelenting questions borrowers have faced.

  1. What does “costs incurred and payments made during the covered period” mean?
  2. How is a full-time equivalent (FTE) employee calculated?
  3. Is it true if a business restores salaries and wages and FTEs as of June 30, there will be no decrease in forgiveness related to a reduction of these amounts?
  4. To what amount does the 75/25% limitation apply?

Remaining are two of the most frequently asked questions—whether forgivable costs include employee bonuses or rent paid to a related party.

PPP loans through the lens of the Application.

In early April 2020, businesses could apply for a PPP loan in an amount equal to 2.5 times of their historical monthly average “payroll costs.” Self-employed individuals, such as independent contractors and sole proprietors, could qualify for a loan in an amount of 2.5 times their average monthly net profit. This is calculated by dividing line 31 on 2019 Form 1040 Schedule C by 12 and then multiplying the result by 2.5, with line 31 being capped at $100,000. What made these loans so attractive is that they can potentially be partially or wholly forgivable.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act, of which the PPP loans are a part, states that eligible costs must be “incurred and payments made” during an eight-week covered period for the costs to be forgivable. As described below, the Application modifies the definition of “Covered Period” (CP) and creates a new Alternative Payroll Covered Period (APCP). Eligible forgivable costs include payroll costs, interest on indebtedness secured by real or personal property, rent, and utilities. Ultimately, we learned that “payroll costs” means gross wages, plus employer contributions for employee health insurance and retirement plans, and state unemployment taxes. Excluded from “payroll costs” are wages of persons living outside the United States, the pro-rated share of compensation over $100,000 per year, and sick leave or family leave wages covered by the Families First Coronavirus Response Act.

There are three limitations on forgiveness after spending the loan proceeds on forgivable costs. First, absent qualifying for the “Exemption for Re-Hires,” commonly described as a “safe harbor,” a decrease in the forgiveness amount is required for certain reductions in FTEs. Second, in the absence of qualification for a safe harbor, a decrease is required if the salary or wages of certain employees are reduced by more than 25%. Third, in an April 15, 2020, Interim Final Rule, the SBA imposed a threshold requiring 75% of the loan proceeds or forgivable costs to be spent on eligible payroll costs.

So, what about those FTEs? A borrower’s forgiveness amount will be decreased if there is a reduction in FTEs, unless the borrower qualifies for the safe harbor. The safe harbor applies if the following two requirements are met: (1) there is a reduction in FTEs when comparing total average FTEs between February 15 through April 26, 2020, to total FTEs in the pay period inclusive of February 15, 2020; and (2) that reduction is eliminated as of June 30, 2020. If the safe harbor is met, there is no reduction in the borrower’s forgiveness amount. If the borrower does not qualify for the safe harbor, the amount of forgiveness is decreased by the application of an FTE reduction quotient.

The quotient is calculated by dividing the average FTEs during the CP or APCP to a borrower’s selected reference period. A borrower whose business is not seasonal may choose between February 15 through June 30, 2019, and January 1 through February 29, 2020. A borrower whose business is seasonal may choose either of those periods or any consecutive twelve-week period between May 1 and September 15, 2019. The FTE reduction quotient is applied to total forgivable costs after any decrease for a reduction in salary or wages, but before application of the 75/25% rule.

Regarding the salary and wage reductions, absent qualifying for the safe harbor, a borrower’s forgiveness amount will be reduced if the salary or wages of certain employees during the CP or APCP is less than 75% of the respective salary or wages for those employees during the period from January 1 through March 31, 2020. Providing additional information on this reduction and the safe harbor risks both your attentiveness and sanity. Instead, we will move on with this promise. Shortly, we will post a separate article to our website that walks through the salary and wage reduction calculation and safe harbor.

Finally, a few answers.

We have an answer to, arguably, the most important of the open questions: what is meant by the CARES Act language “costs incurred and payments made during the covered period.” Does this language refer to costs accrued or costs paid during the CP? The answer—both.

  1. It is costs incurred and costs paid.

The Application modifies the definition of CP and, for payroll costs only, creates a new period called the Alternative Payroll Covered Period. The CP is expanded so that eligible costs incurred during the CP are treated as forgivable, even if the costs are paid after the CP, provided that payment of the costs is made on or before the next regular payroll or billing date. Payroll costs are considered “paid” on the day that paychecks are distributed, or the borrower originates an ACH credit transaction, and are “incurred” on the day that the employee’s pay is earned.

Concerning payroll costs, companies no longer have to worry about fitting their payroll into an artificially chosen eight weeks. Instead, borrowers with a bi-weekly, or more frequent, payroll schedule may elect the APCP, an eight-week (56-day) period that begins on the first day of the first pay period following the borrower’s PPP loan disbursement date. For example, if the borrower received its PPP loan proceeds on Monday, April 20, and the first day of its first pay period following its PPP loan disbursement is Sunday, April 26, the first day of the APCP is Sunday, April 26 and the last day of the APCP is Saturday, June 20. As with the CP, costs incurred but not paid during the APCP are eligible for forgiveness if paid on or before the next regular payroll date. Again, the APCP applies only to payroll costs. For borrowers that elect the APCP, the CP continues to apply to non-payroll costs.

Therefore, costs paid during the CP or APCP are forgivable, even if incurred before those periods. And, costs incurred during and paid after the CP or APCP are forgivable provided that payment of the costs is made on or before the next regular payroll date or billing date. Costs that are both paid and incurred may only be counted once.

  1. FTEs are calculated using 40 hours per week or a simplified method.

The educated guesses that the SBA would use 30 hours per week were just that—guesses. To compute its FTEs, a borrower must take the number of hours paid per week, divide by 40, and round the total to the nearest tenth. However, an employee working over 40 hours per week can only count as a maximum of 1.0. Borrowers may elect a simplified method in which an FTE of 1.0 is assigned to an employee that works 40 hours or more per week, and an FTE of 0.5 is assigned to an employee that works fewer than 40 hours per week. The most advantageous method will depend on each borrower’s facts. The Application also provides that a borrower will not have its loan forgiveness reduced if FTEs cannot be restored because an employee rejects a good-faith, written offer of rehire, is fired for cause, voluntarily resigns, or voluntarily requests and receives a reduction of their hours.

  1. ON June 30, really?

The answer appears to be yes, really. The FTE safe harbor provides that if FTEs between February 15 and April 26, 2020, decreased, a reduction in forgiveness is avoided provided that “as of” or “not later than” June 30, 2020, the borrower restores the FTEs to the FTE level for the pay period including February 15, 2020. A similar safe harbor exists for certain salary and wage reductions. There is no reduction in forgiveness amount if the salary and wage reductions are eliminated as of June 30, 2020.

  1. 75/25% of what?

The 75/25% rule requires at least 75% be spent on payroll costs. Previous guidance was inconsistent as to what amount the 75% was to be applied. Is 75% of the loan amount to be spent on payroll costs, or is it 75% of the amount of requested forgiveness? Per the Application, the forgiveness amount is the lesser of (i) total eligible payroll and nonpayroll costs less adjustments for FTE and salary/wage reductions (referred to as the modified total potential forgiveness amount), (ii) the PPP loan amount, or (iii) total payroll costs divided by .75. If that makes your head spin, it’s okay. The bottom line is the 75% is not applied to loan proceeds, but instead to something akin to the requested forgiveness amount.

That’s it.

The questions of whether forgivable costs include employee bonuses and rent paid to a related party remain. As we have told many of you, there is nothing in the statute or existing guidance that prohibits these costs from being forgivable, nor is there anything that describes them as forgivable.

Anything else?

Two additional areas of the Application deserve mention—certifications and documentation. The Application requires the borrower to certify several things, including:

  • The dollar amount for which forgiveness is requested was used to pay costs that are eligible for forgiveness; includes all applicable reductions due to decreases in the number of FTEs and salary/hourly wage reductions; does not include non-payroll costs over 25% of the amount requested; and compensation for any owner-employee or self-employed individual/general partner does not exceed eight weeks’ worth of 2019 net earnings, capped at $15,385 per individual.
  • If the funds were knowingly used for unauthorized purposes, the federal government might pursue recovery of loan amounts and/or civil or criminal fraud charges.
  • The SBA may request additional information to evaluate the borrower’s eligibility for the PPP loan and loan forgiveness, and that the borrower’s failure to provide the information requested by the SBA may result in a determination that the borrower was ineligible for the PPP loan or a denial of the borrower’s loan forgiveness application.
  • The SBA may direct a lender to disapprove the borrower’s loan forgiveness application if the SBA determines that the borrower was ineligible for the PPP loan.

In light of the SBA’s heavy, after-the-fact reliance on the necessity certification in loan applications, borrowers should carefully read and consider what they are certifying.

The Application devotes a full page to the documentation required to be submitted with it. The Application consists of four parts: (1) the PPP Loan Forgiveness Calculation Form (Calculation Form); (2) PPP schedule A; (3) PPP schedule a worksheet; and (4) Documents that each borrower must submit with its PPP Loan Forgiveness Application.

The Calculation Form and the PPP Schedule A must be submitted to the lender. The PPP Schedule A Worksheet, or its equivalent, is not required to be submitted but is required to be maintained by the borrower. The documentation of payroll costs, FTEs, and nonpayroll costs to be submitted are described in detail, as is the documentation to support the PPP Schedule A Worksheet. The borrower must retain all documentation in its files for six years after the date the loan is forgiven or repaid in full, and permit authorized representatives of the SBA, including representatives of its Office of Inspector General, to access the files upon request.

Dean Dorton is committed to continuing to provide support to individuals and businesses during these complex times. Reach out with questions to your Dean Dorton advisor, another professional advisor, or email us at info@deandorton.com.

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For more information on how the Coronavirus is impacting businesses across multiple industries, visit our COVID-19 resource page:

COVID-19 Resources

Filed Under: Accounting Software, COVID-19, COVID-19 Business, COVID-19 SBA Loan Programs, COVID-19 Tax Tagged With: Borrowers, COVID-19, Forgiveness, Loan Application, PPP Loans, SBA Loans

Article 05.19.2020 Dean Dorton

Meet the Participants

JOHN BRADFORD
Chief Financial Officer
Murray-Calloway County Hospital
Murray, KY

CHARLIE CREVLING
Chief Financial Officer
Valley View Hospital
Glendwood Springs, CO

JENNIFER WILLIAMS
Chief Financial Officer
Wayne HealthCare
Greenville, OH

ADAM SHEWMAKER
Director of Healthcare Consulting
Dean Dorton
Roundtable Moderator

Adam Shewmaker, Director of Healthcare Consulting at Dean Dorton, provides an introduction to the virtual roundtable.

Download full discussion

JOHN: All areas have been impacted, some areas more acute than other areas. We’ve experienced an overall revenue decline of around 50% with surgery and endoscopy procedures down 75% or more. Physician office visits and other outpatient diagnostics are down 25% to 50%. Operationally, we had to change an entire floor to a COVID-19 unit, which is now 20 beds that are no longer available for all other patients, and our census on that floor is three to five patients per day. We also have a skilled nursing unit with an average daily census of about 125 so you can imagine the impact on the staff and patients there, with the heightened sensitivity to the virus. Maybe more significant is the impact on the front-line workers. At work they have to deal with how to safely admit and take care of patients and find PPE, but when they’re away from work, they have to deal with all the limitations and restrictions as well. So there is little escaping it for them.

CHARLIE: We experienced similar impact on revenue, down 45%, and we’re projecting about a $30 million drop in income related to COVID-19 this year. Most of outpatient is basically shut down, including outpatient surgery, which is a revenue engine for the hospital. ER visits are down dramatically and patient census is down. In shutting down our departments, we guaranteed our staff two months of pay, trying to mitigate circumstances for them. We’re in a fortunate position to be able to do that; not all organizations are able to do so. It’s been pretty hard on the organization and we’ve had the same PPE issues that John referenced—we’ve had volunteers and staff making masks and gowns—this has completely disrupted our operation and we’re just slowly starting to bring back some of our elective cases.

JENNIFER: Same here. We did a code yellow and instant command on March 13. The government shut down any surgeries that were elective, so for half of March and for the entire month of April, as much as 85% of all services were shut down. Our governor just released that we could go back to doing outpatient surgeries—no surgeries that require an overnight stay start back up on May 4. Our gross revenue was down about 50% for both March and April. We were informed to prepare for 150 COVID-19 patients, but we have only 63 beds, so we lost most of our outpatient revenue and we were turning many beds into COVID units to prepare for the surge. When we talked about the PPE being a problem, the community stepped up and made us gowns, masks, etc. We were then told our surge was going to go be much higher—our county is a very elderly county so we were concerned with how the nursing homes would be hit, and how many patients we would have.

JOHN: As for volumes and revenue, we’re doing what we can but we’re limited by the restrictions set by the state and timelines they’ve set up, as well as some of the self-imposed restrictions by the patients themselves. We’ve been told we can start some elective procedures, but all patients coming into the hospital must have a mask, must have been tested for COVID, with results back, and also we must have a certain amount of PPE on hand in case a surge was to occur. We might be ready to see all of these patients, but if one of these requirements isn’t met, we’re not supposed to be having elective procedures.

We’re finding that some patients with life-threatening conditions are more worried about contracting the virus by a visit to their physician or the ER, than they are about coming in to take care of their condition. They’re more worried about COVID than their life-threatening condition. We’ve adopted telehealth solutions so the physicians can see more patients. It’s going to be difficult to move the needle in any meaningful way on volume in terms of the restrictions than probably more availability of PPE. From a staffing standpoint, we didn’t take a drastic reduction in staffing during the first five or six weeks of the pandemic as we wanted to keep staff as whole as possible. We told them we wouldn’t make any drastic reductions until we absolutely had to. This also gave us time to cross-train staff in some areas where the pandemic would hit us hard. We’ve asked managers and directors to be more accessible (not that they weren’t already), but when a large portion of your staff is working from home, it can be difficult to be more accessible. We’ve also adopted virtual meeting technology, like most places have, and we’ve had virtual town hall meetings to discuss current events, employment insurance assistance, etc.

And our community has been great in showing their support in making everyone here feel how important they are. Our staff are working with sick patients all day and are concerned about coming down with COVID themselves, and then they have to go home with those restrictions, along with reduced staffing overall—it’s just a hard line to walk.

CHARLIE: We were a little less restricted. We’re ramping up outpatient surgery to about 50% from where we were pre-COVID, and slowly getting there. We’ve turned the areas we had to shut down into labor pools and rotated those employees through other departments, like materials management, to help in some of these areas where we were overwhelmed. It has helped in keeping people involved in the hospital. We created a COVID award of the day to just give people some recognition—some of the employees, especially housekeeping and environmental services, receive those awards as a group.

What really helped was management talking with staff about COVID mortality rates. There was a lot of misinformation for a time and our staff were scared to go to patient rooms. Just that education piece helped quite a bit. Many people who were laid off have no savings. We’re bringing all of our services, the clinics and more, back online slowly, and we’re reaching out to patients. Like John said, there are people who really need care and need to be seen in the clinics who aren’t coming to get it (e.g., patients with diabetes, COPD, or heart failure)—whether the care is via a phone call/tele-visit, or coming into the office in person. One thing I think that’s helped morale and our standing in the community is the hospital’s foundation. The foundation has gotten quite involved with donors to find and donate PPE to those impacted.

JENNIFER: Three weeks ago, we created a committee to start looking at different areas that we closed, like outpatient therapy and some of our diagnostic assessments. Our lab hours were shortened and closed some of the days we were open, our senior behavioral health unit was pretty much closed as soon as we had every patient discharged, and diagnostic imaging was closed. With the help of that committee, we implemented a soft start on some of the diagnostic outpatient areas that we could do in-house. Outpatient therapy started working two days a week, started getting patients back, starting doing the six-foot distancing they needed to keep themselves and their patients healthy. Then they increased to three days, then four days, and should be at five days a week in May.

We made a lot of staffing changes here; we laid staff off, we had three early retirements, and we have six positions that we rightsized and will no longer bring back. Our full-time employees who were working 40 hours are now working 20 hours. We’ve made these significant changes to our salaries/wages to offset our reduced revenue. Those positions will come back as the need is there, as patients start returning. We will start doing outpatient surgeries, like colonoscopies and other similar procedures, on May 4.

In terms of morale, we’ve had a lot of support from the community—many lunches and dinners brought in for hospital employees. Community members have stepped up to do breakfast for everyone at the hospital. Our foundation has a program called We Care, which provides confidential support, through the foundation, for employees (or spouses) who are laid off or who have experienced reduced hours.

With the surge of COVID patients that we were supposed to have, a hospital in Dayton with which we’re affiliated turned one of their hospitals into a 250-bed COVID hospital. We have currently shut down all our COVID areas and we have turned our six-bed ICU unit into a COVID investigation. So starting today, if we get a patient we think has COVID, they are getting placed in ICU to rule out. If the patient tests negative and has medical conditions, then they go to that specific unit for treatment. If they test positive, they transfer from our hospital to the affiliated hospital that has 250 beds to treat COVID patients. We are probably going to make our hospital a well hospital, COVID-free, and that will help the community feel more at ease to come here and get elective surgeries done.

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Filed Under: COVID-19, COVID-19 Industries, Healthcare, Industries Tagged With: COVID-19

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