COVID-19 Next Steps & Practice Resources    Learn More…

COVID-19

Next Steps

We recognize you have many questions regarding your practice right now and how to best contend with the impacts of COVID-19.

Please review your state specific recommendations, public health department recommendations, and dental association websites for the most current updates on suspension of non-essential treatment. This request comes as an effort to preserve limited supplies of PPE for emergency dental treatment and frontline healthcare personnel dealing with COVID-19. We’ve put together a resource to help you make informed decisions. Please continue to check the ADA’s site, the CDC site, and your local health authority’s site for updates as well.

 

Legislation

Department of Labor Guidance on Family First Act – ACTION REQUIRED by 4/1/2020

By April 1st, each covered employer must post a notice of the Department of Labor’s poster detailing employees’ rights under the Families First Coronavirus Response Act’s requirements in a conspicuous place on its premises. OR, an employer can satisfy the posting requirement by emailing or direct mailing the notice to employees or posting the notice on an employee information internal or external website. The poster covers paid-leave entitlements, employee eligibility, and qualifying reasons for leave related to COVID-19 and enforcement. (Download a PDF of the DOL Required Posting of Notice of FFCR Act poster.)

We will update this site as soon as the Department of Labor publishes the criteria that small businesses with fewer than 50 employees will need to meet to qualify for the exemption as well as potential exemptions for certain health care personnel, which may include dental staff. Watch for updates on the ADA site.

 

Additional Links

EmployeesDOL Fact sheet on FFCR Act

EmployersDOL Fact sheet on FFCR Act

FAQs from DOL on FFCR Act

Senate passes and Trump signs Families First Bill March 18th.

The Families First Coronavirus Response Act aims to provide relief to workers and families during the COVID-19 outbreak. This Act includes a number of provisions directly affecting employers and the enacted version contains a number of changes from the bill first passed by the House of Representatives on March 14, 2020. Read more from the Department of Labor…

The House passed the Coronavirus Bill March 14th.

The House passed the Coronavirus Bill March 14th. Senate lawmakers are reviewing the Families First Coronavirus Response Act, which would provide free screening, paid leave, and enhanced unemployment insurance benefits for people affected by COVID-19. This current version provides for an effective date of 15 days following enactment.

  • Part of this Act includes an Emergency Family and Medical Leave component. Although FMLA leave normally applies only to employers with 50 or more employees, this public health emergency leave would be available to ALL employers with fewer than 500 employees.*
  • Employers would receive a payroll tax credit to cover 100% of paid sick leave and paid FMLA leave, up to $200 per employee per day.*

*Not included in the final bill signed on March 18th.

States have significant flexibility to amend their laws to provide unemployment insurance benefits.

States have significant flexibility to amend their laws to provide unemployment insurance benefits for employees who lose work because of effects of COVID-19, according to guidance issued by the U.S. Department of Labor.

  • Emergency grants would be available to allow states to process and pay unemployment benefits.
  • Requirement for the applicant to be actively applying for work may be waived.
  • State Dental Associations will certainly be advocating for economic relief packages as well.
Companies implementing work from home where possible.

Companies are sending employees home to work, if possible, or temporarily closing to curb the transmission of COVID-19.

Social Distancing

In order to observe social distancing, practices are staggering schedules so multiple patients are not seated in the reception area at the same time. Those accompanying patients are being asked to remain in the reception area, rather than entering the clinic area.

ADA Lobbies Congress on CARES Act

On March 20th, the ADA sent out an alert to dentists, assuring them that they continue to lobby on their behalf in response to the Coronavirus Aid, Relief and Economic Security Act (CARES). Read more from the ADA…

Economic Relief

Relief packages are currently in process through the federal government, check with your CPA and attorney for the latest offerings to take advantage of the programs available to you. In the meantime, many banks are offering 6-month deferments for loan payments without penalty or interest.

  1. The ADA is requesting specific relief for dentists. Follow their progress in this effort on their website.
  2. U.S. Small Business Administration is offering relief to businesses impacted by COVID-19.
  3. The IRS has provided guidance regarding the Families First Coronavirus Relief Act.
  4. Individual state, county, and city websites may offer additional relief.
  5. Federal and state tax assistance may be available; check your local sites.
Additional Relief Bills

Additional relief bills are underway in Washington, D.C. Check back for updates.

Taking Care of the Practice During a Temporary Closure

The temporary closure of your dental practice was likely a stress-inducing event for the owner, staff, and patients. In a time of crisis, it can be helpful to focus on the next step forward, which includes the steps you are taking today to ensure a smooth return when the spread of COVID-19 is controlled.

Current Workflow

Many states have mandated the ongoing care of patients for emergency treatment during your temporary closure to reduce pressure on local emergency rooms. You will need to connect with previously scheduled patients to reschedule their appointments. You will likely field more calls than normal from anxious patients. You need to collect as much as possible, which requires the filing of claims, tracking down unpaid claims, and sending narratives or requests for reviews to insurance companies. You will also need to provide limited care during this time. The steps outlined below will provide needed support for ongoing workflow as well as a smooth transition back to full operations.

  1. Keep a part-time front office team member on the payroll for as long as the budget will allow. Ideally, this person is cross-trained to assist with emergency care. If the budget will not allow, you will need to take on the responsibilities outlined.
  2. Be sensitive to unemployment laws and offer hours to allow your staff to take advantage of federal and state programs.
  3. Maintain reduced phone hours (4 hours per day) to answer phones and return messages. Direct patients to the doctor’s emergency line for after-hours calls.
  4. Work on collections and reducing your aging AR. Review denied claims, file review requests and collect monies owed. It is critical to infuse as much cash flow into the practice as possible.
  5. Reschedule patients into the future to make sure you come back to a full schedule. You may not know the exact return date as information is changing quickly, but it will be easier to move an appointment a second time than it will be to come back to an empty schedule. Push patients out to the most recent return-to-work date you have from the authority in your state.
  6. For patients who are not comfortable rescheduling at this time, track them on a short call list. That will be your immediate go-to scheduling list when you return.
  7. Identify patients who need treatment right away to prevent an emergency. The ADA has provided guidance on the definition of emergency care.
Patient Communication

Most everyone in our country has read about the COVID-19 pandemic and are adjusting to changes in their daily lives. However, many do not consider dentistry to be elective, and learning their trusted practice and provider is temporarily closed will cause anxiety and stress. That is especially true for patients who have an existing treatment plan. A needed filling may feel like an emergency to them. Calm their fears with good verbal skills when rescheduling patients and communicate frequently with patients through social media during your closure.

  1. Do not send a letter to the entire patient base to announce the temporary closure, as this may create unnecessary fear for patients who will not experience an impact during this time.
  2. Call each patient on the schedule to reschedule their appointment; reassure them they will have priority scheduling and select a date. Remind them of your availability if they have an emergency and to not hesitate to call.
  3. Communicate daily via social media channels or your website. Post something fun, perhaps of staff weeding their yard or doing a puzzle – anything that reflects life as normal with a daily reminder you are still there, can see emergencies, and hope everyone is staying safe and healthy.
Staff Communication
  1. Communicate frequently, even if you do not have all the answers! Your staff is looking to you for leadership and direction. The communication you provide now will have a lingering impact on how supported they feel during this time.
  2. Set up a group text so everyone can continue to connect. Share budgeting tips, pictures, news, and create a forum to ask questions of each other. A few budgeting tips you can share:
    • Spouses/partners of displaced staff can temporarily stop all 401K contributions to increase cash flow
    • Some banks are allowing a deferment of mortgage payments; it does not hurt to call and ask. This may be true for utility companies as well.
    • Check with state and federal programs for unemployment or other packages that may be available to them.
  3. Send detailed updates via email to the staff. Send a text in the group text to ask everyone to check his or her email when an update is available. Text messages tend to be checked more frequently than email, but messages can be lost and it’s difficult to send detailed information in that format.
Return to Work Steps
  1. Consider adding additional days or hours to your schedule when you return. You should have a higher demand on your return with many overdue patients. Additional availability will help meet patient demand, allow opportunities for staff to make up for lost wages, and increase collections more rapidly. Touch-base with your staff as your return date gets closer to check availability.
  2. Know your equipment and follow guidelines to restart and recalibrate. Plan to run test strips in sterilization equipment on your return. Run waterlines using appropriate disinfectants.
  3. Take steps to ensure a sterile environment on your return for the safety and peace of mind for patients, staff, and yourself.
  4. This crisis likely increased sterilization efforts and techniques; determine which of those will continue indefinitely as part of your new protocol. For example, if you started wiping down door handles, front desk counters, and reception areas as a new protocol, communicate which of those you expect to become part of the new norm moving forward.
  5. The EPA recently released a list of approved disinfectants that are effective against COVID-19.
Practice Support Team Resources

A crisis creates an opportunity to re-evaluate your goals, your practice systems, and allows time to reflect on changes you would like to make in the future. This is an ideal time to determine growth opportunities for the practice that can be put into place on your return. It will also provide hope and synergy for your team.

Burkhart offers several no-cost analyses to provide insight into areas where you are succeeding as well as identifying growth opportunities.

  • Practice Analysis. With two easy-to-print reports, we can provide an analysis that reviews 8 key areas of the practice and compares your data to healthy benchmarks. We set up a time for you to speak with one of our consultants to help you strategize for improvements.
  • PPO Analysis. Let us help you by calculating the average adjustment per plan and provide recommendations for re-negotiating contracts or limiting exposure to high write-off contracts.
  • Coding Analysis. We can help you maximize your insurance reimbursement through proper coding strategies.
  • Associate Readiness Assessment. We would be happy to evaluate your practice to see if it’s a good time to add an Associate.
  • Overhead Analysis. We can compare your overhead numbers to healthy benchmarks in the dental industry and strategize with you to reduce your overhead.

Please let us know how Burkhart can come along beside you during this time to ensure you come back to a stronger, healthier practice in the future.

Equipment & Technology Care for Temporary Closures

In the event you plan to temporarily close your office, or if you have already closed your office, here are some things to consider if you’re going to be closed for an extended period – these will help make returning to business easier.

  1. Has your Mechanical Room equipment been shut down properly?
  2. Have you flushed each of your delivery systems?

During this challenging time, we remain committed to being a resource for you and your practice. We can schedule a Service Technician to help you through the process. Call your local branch or customer service to set up an appointment. We’ll cover the trip charge.

*Note: The above recommendations are intended to support and protect your practices’ equipment during temporary closure, but do not guarantee the elimination of equipment failures.

What Your Team and Patients Need Now: Communication & Reassurance

You’ve made the tough decision to temporarily close the practice, some of your team members may have been furloughed or placed on standby and one or two others may be working a reduced schedule to check mail, post payments, and assist with emergency patients. Even if you’re still trying to understand the situation you’re in, it is a critical time to stay engaged with your team members and your patients.

When dealing with uncertainty, it’s probably not possible to over-communicate. Remember your goal of helping your team and your patients feel safe in order to help your practice rebound back when the pandemic subsides. Now is your time to shine as a leader; your staff and patients are counting on you.

Your Dental Team

In fast-moving and uncertain situations, leaders face questions they may not have the answers to. In these situations, communication is key. Your team wants to know they’ll have a practice to come back to and life will return to normal. They are looking for emotional safety and they are counting on you as their leader to support them. So, what do you do?

Communicate

  • The unknown is scary. What is your plan to get through this tough time? Share as much as you know.

Continue to share with your team

  • Set up a group text for the team to communicate in fun ways and stay connected.
  • Set up a group email for the team. If you are sharing important information, that would be cumbersome to include in a text, send it in an email. Text the group to expect an email as many people check their texts more frequently than their email. Select a format that is dated and easy to follow as you will likely send frequent email updates. Plan to update the team at least every other day so they feel they are in the loop regarding rapidly changing recommendations that may impact the practice.
  • Empathy is key right now; make a goal to reduce the stress of uncertainty.
  • Be the leader of the practice and the main source of information; don’t delegate this.
  • Text the group every day – A quick update on the practice and something that helps the team members connect. What did they binge-watch last night? What local take-out place is still open? Have they read a great book? Encourage the team to post pictures of what they are up to.
  • Explain what you know, what you don’t know yet, and your sources of information.
  • Connect via FaceTime with each team member so you can “see” each other.
  • Are you using the time to get better at something? Share this with your team.
  • Your team will be impacted by the tightening economy, ask for tips on what everyone is doing to budget right now. Share helpful budgeting resources or tips you’re using to save money.
  • Don’t forget birthdays and practice anniversaries – you can still celebrate them remotely.
  • Your team members are ambassadors for your practice in the larger community; put their minds at ease.
  • Try to provide timely information rather than waiting until you have all the answers.
  • Connect for virtual meetings, if appropriate, as a team even if it is for a few minutes each week. Zoom and Skype are two free options.
  • Many virtual CE offerings have been discounted; the ADA has 50% off CE courses online through 3/30/2020.

All of these efforts will help reassure your team and make it easier to pull the team back together when the practice opens again.

Your Patients

Focus on what’s important to your patients. Your patients want to know they’ll have a practice to come back to as well. They are also looking for emotional safety and they are counting on you as a medical professional to reassure them.

Share regular updates with your patients

  • Pick a social media channel that is strong for your practice and post something on the practice feed daily.
  • Be the voice of your practice, don’t delegate this.
  • A short, sweet message is fine.
  • Authentically, try to reduce the stress of uncertainty and demonstrate empathy.
  • Remind patients best ways to connect with the practice if they have an emergency.
  • Share photos or videos of the Doctor(s) or team along with your post (everyone is tired of seeing the Coronavirus germ now).
  • Keep valuable patient relationships growing. Ask patients what they are doing – hiking, kayaking, walking their dog, hanging with their kids, reading a great book?
  • Say thank you to local businesses and caregivers in your community.
  • Post about the dentistry you want to be doing more of.
  • Post pictures of offices you refer to and champion their practice as well.
  • Got a new song you’re washing your hands to? Post a video.
  • Your patients will be impacted by the tightening economy; share budgeting resources or tips on saving money.
  • Many of your patients are working from home; share tips on productivity and balance.
  • Share ways in which you’re helping local, national, or global communities in crisis.

Recommended Protocols for Patients Seeking Emergency Care

For help defining what constitutes a dental emergency, seek advice from your local dental association and the ADA. (Download an explanatory PDF from the ADA.) To help your patients better understand what a dental emergency is, share this ADA resource on your social media pages.

Patient Screening – ADA Recommendations

The ADA recommends that patients be screened for active disease prior to providing dental care in the office. Take note of:

  • Patients who exhibit or report signs of respiratory illness such as coughing, fever, and shortness of breath. Include temperature readings.
  • Recent travel to locations designated by the CDC to have a Level 3 Travel Health Notice for COVID-19. Verify when the patient returned to the United States.
  • Close contact with an individual, such as a family member or co-worker, diagnosed with COVID-19 within the last two weeks.
  • Encourage patients who respond “yes” to these questions to contact their primary physician or public health department as soon as possible to determine if they should be seen or tested.
Once Appointed – ADA Recommendations

Once appointed, the ADA recommends:

  • In small waiting rooms, offering less than six feet of distance between patients, request patients wait in their cars and receive a phone call or text message when it is their turn for treatment.
  • Patient and dental healthcare workers should perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after possible contact with respiratory secretions and contaminated objects/materials.
  • Include temperature readings as part of your routine assessment of the patient prior to performing dental procedures.
  • Avoid or minimize operations that can produce droplets or aerosols.
  • Use rubber dams whenever possible.
  • Rinse the oral cavity slowly, avoiding unnecessary splatter.
  • Use high-speed evacuation for all dental procedures producing an aerosol.
  • Autoclave handpieces after each patient.
  • Have the patient use an antimicrobial rinse before appointment; ADA suggests using 1% hydrogen peroxide.
  • Avoid or minimize procedures that may induce coughing, such as taking routine intraoral X-rays.
ADA Webinar – COVID-19 Infection Control Protocols & Procedures Webinar – 1 CE Credit

On March 20, 2020, the ADA teamed up with leading infection control experts from OSAP to provide the dental community with practical guidance and education as we navigate the challenges associated with COVID-19.

The complete webinar is available to watch and earn 1 free CE credit.

Use Teledentistry to Screen Patients

Teledentistry is a safe option to screen patients for emergency care while reducing the spread of COVID-19. Offering teledentistry also supports the federal objective of limiting the use of emergency rooms for dental related issues.

Teledentistry services, when coded properly, are billable events. Download the list of proper codes and frequently asked questions from the ADA.

Please note, no special technology is needed to deliver teledentistry services during the pandemic. Since healthcare systems are facing uncharted territory in managing the COVID-19 outbreak, concessions have been made to assist healthcare providers in delivering this service. The Department of Health and Human Services announced that “Providers will be allowed to use everyday technologies to talk to telehealth patients.” The HHS Office of Civil Rights has also stated it will waive any potential HIPAA penalties for use of telehealth during the COVID-19 emergency. If a practice needs help with setting fees for this service, they can reach out to Practice Support Team for guidance.

What You Can Do Now to be Proactive

Review Your Sick Leave Policy
  • Ensure policies follow state-mandated paid sick leave policies and employees are aware of these policies.
  • The CDC has encouraged employers to maintain flexible policies allowing employees to stay home to care for sick family members and be aware more employees than usual may need to stay home.
  • The CDC advises employers not to require a healthcare provider’s note to validate an employee’s illness since healthcare facilities may be extremely busy and unable to provide documentation in a timely way.
Communicate with Your Team
  • Be the voice of your practice and lead your team. Consistency in communication is key in uncertain times. Having one voice lead that effort and responding to questions is critical.
  • Employees should be made aware some of the preventive measures recommended by the CDC might result in a loss of income if an employee has exhausted paid sick time or other paid time off.
  • Ensure you have updated contact information for all of your employees to include home addresses, phone numbers, and updated emergency contact information.
  • Establish a staff phone tree or group text to keep each other up-to-date on possible exposure or office closure.
  • Advise each team member of their accrued PTO and PSL.
  • Consider who your “skeleton team” could be so you can continue to meet emergency patient needs while being prudent with your staff overhead.
  • Bear in mind school closures and illness may affect some of your team members’ availability.
  • Staff experiencing illness (fever with or without cough) should not report to work.
  • If the practice closes or operates at a reduced staff level, set up a regular cycle of communication to check in with your team members and keep them informed of developments/changes over the weeks you are closed/operating with reduced staffing.
Communicate with Patients
  • Develop a communication plan for how to reach patients in the event the office is closed. Use phone calls, texts, emails, and the practice’s social media pages to get the message out. Offices also need to keep track of area school closings and health department updates.
  • Use the resources above as a template for your communication with patients.
  • If you are still able to see patients other than emergencies, continue your practice marketing efforts and focus attention on recare calls.
  • Many students are home currently for several weeks. Now may be an ideal time to reach out to these patients and schedule appointments.
  • Consider using text messaging to promote social distancing; encourage patients to wait in their cars until their operatory is ready, text them to come right back to the clinic area.
Ensure Remote Abilities Are in Place
  • Can your Practice Management System be accessed off-site? Do you and your Office Manager have the ability to access from off-site should your office manager work remotely? If this has not been set up previously, consider doing so now.
  • Is your payroll system accessible off-site? If this has not been set up previously, consider doing so now.
  • Review your cybersecurity policy with your team. Ensure patient data and practice data is protected when accessed off-site by a strong firewall, appropriate encryption and strong, secure passwords.
  • Set expectations for your team members working from home regarding what work they will do, the quality expected, and set deadlines for completion of tasks. Working remotely can be a huge change for people and clear expectations are necessary and helpful!
  • Out of sight, should not be out of mind. Set up a cycle of communication with any team members working remotely on behalf of the practice.
Consider Staffing Plans
  • In the event of a potential staff shortage, employers should prepare alternative staffing plans. Proactively reach out to local dental staffing services.
  • Plan for if you should fall ill; reach out to your coverage network to ensure ER patients can be seen.
  • Compute your staff overhead to better understand the minimum you need to produce to maintain your current staffing levels. (Staff overhead includes wages, payroll taxes, health insurance and additional benefits, other than retirement benefits. A healthy staff overhead is in the range of 20-30% of collections).
Resources for Downtime

Uncertainty remains a stressor as dental employers and their teams deal with the impact from COVID-19.  There are things you can do, even while at home, to keep the focus on a successful return to operations.

 

Free/Reduced Cost Online CE Options

ADA CE Courses

Dental Care CE Courses – Crest & Oral-B

Colgate Oral Health Network CE Courses

Viva Learning

Proctor & Gamble CE Courses – Dental Network of America

Hu-Friedy CE Courses

Glidewell Dental CE Courses

ADHA CE Courses

 

No-Cost Burkhart Support

Practice owners and managers will benefit from taking advantage of Burkhart’s no-cost analyses to review a variety of business aspects. Burkhart’s Practice Support Team is standing by to provide analytical data and phone support to help during this critical time. Prepare now for stronger systems to get you up and moving quicker on your return.

  • Practice Analysis
    Gain an overview as we compare 8 critical areas of your practice to healthy benchmarks. With just two reports from your practice, we can analyze your data, provide kudos, and strategize via phone with you for identified growth opportunities.
  • PPO Analysis
    Receive a detailed analysis of the plans you are in contract with and recommendations to reduce your exposure, or re-negotiate your fee schedules.
  • Coding Analysis
    Get back to work knowing you are utilizing coding strategies to maximize your reimbursement.
  • Overhead Analysis
    Know how you compare, in each overhead category, to healthy benchmarks. We can help you right the ship.
  • Facilitated Team Meetings
    Schedule a time to have one of our consultants join your staff meeting to review analyzed reports or best practices to improve the patient experience, staff communication, and business systems.
  • Other questions?
    We are here for you; give us a call 1.800.665.5323, or shoot us an email PracticeSupportTeam@BurkhartDental.com.

Economic Support

Financial Next Steps
The coronavirus pandemic quickly altered your dental practice business. Many of you have already had to make tough financial decisions. In a time of crisis, it can be helpful to focus on the next step forward, which includes the steps you are taking today to ensure a smooth return when the spread of COVID-19 is controlled. Your goal is to emerge from this crisis as “whole” as possible. While there are no easy answers right now, assessing where you are currently and tackling what you can now, will be helpful financially and mentally moving forward.

 

Determine Your Baseline Before the Crisis

Once you determine your baseline, make the applicable adjustments for any expenses you can temporarily reduce. The net result after adjusting your monthly collections and expenses is your net cash flow per month.

Practice Costs Breakdown during COVID-19

 

Forecast Your Revenue for Next Two Months as Best You Can

A practice with managed care contracts will continue to receive income as claims and accounts receivables are paid. This also applies to Fee-for-Service practices that have not yet collected older AR and claims they have submitted on behalf of their patients. There could be potential revenue generated from ER dental care as well as any tele-dentistry fees collected.

 

Identify Opportunities to Generate Revenue

Some practices remain open for a limited number of hours to provide emergency dental services or are open as-needed to provide urgent dental care. Some practices are also offering tele-dentistry as a tool to identify and support patients who need urgent dental care.

 

Consider Ways to Decrease Payroll Expenses

You are not alone in having to make some tough decisions about your team. Congress is addressing this need; we should know soon what the new bill will offer businesses and employees to help weather this crisis.

Options for You to Consider:

  • Reduce Hours: Hourly, nonexempt team members are paid only for the hours they work. Exempt employees are on salary, which means they are entitled to their entire salary, even if they work a reduced schedule.
  • Furloughs: A furlough is a temporary layoff from work. Team members are not paid during furloughs, but they do keep employment benefits such as health insurance. Employees are not allowed to do any work for you while they are on furlough.
  • Layoffs/Terminations: A layoff can be either temporary or permanent; the employee is dismissed from their job. The person would need to be rehired to come back on payroll.
  • Standby: Some states are offering a standby designation during this time. The employee collects unemployment, if qualified, and has an anticipated rehire date with their employer. In most states, the employee must have been full-time.
  • Discontinue Doctor’s Payroll: Consult your accountant to see if you can take distributions in lieu of payroll.

Bear in Mind:

  • Dental practices that offer paid sick time and/or vacation time typically need to pay any accrued hours to terminated employees (check your specific state regulations).
  • Double-check your current employee manual to confirm how your PTO policy is structured.

 

Reduce and/or Defer Rent

If you haven’t already, call your landlord to ask if you can lower or even defer your rent for April and May. This is a situation you hopefully have never been in before. Make them aware you have very limited income coming in and once restrictions are lifted, you can resume business and your (full) payments.

 

Reduce, Defer, Eliminate Costs

You should immediately decrease dental and office supply orders to only what is needed in the immediate future. If you pay for a service you will not be using while you are closed, ask about pausing services. If you are making monthly payments to a marketing firm to boost posts, etc., consider stopping those payments and efforts for the next few months. Create a listing of all vendors, what your current monthly payments are, what reduced fee they have agreed to, and a column for notes. This will be helpful to reference once your practice is fully open again.

 

Reduce or Refinance Debt Payments

You should call your lender to ask about reducing or refinancing debt payments; making interest-only payments on your business loan; decreasing any excess principal payments; or lengthening the term of the loan. The federal government has allowed federal student loan borrowers to pause their payments for 2 months (this may change), at which time interest is being waived. Some of the larger financial institutions have paused payments on loan obligations for 3-6 months to assist in the recovery effort.

Contact your bank to apply for a line of credit, if you do not already have one. There may be an opportunity to draw against available lines of credit on the business or personal property, if needed.

Now’s a good time to contact your credit card company to see if there is a penalty for missing a payment, or if they will allow you to skip a payment without penalty.

 

Additional Options

Dentists who need access to cash resources during the next few weeks should also talk to their accountant/financial planner for additional options. These could include temporarily stopping automatic contributions to your retirement plans or taking a loan against your 401K.

ADDITIONAL FINANCIAL RESOURCE LINKS RELATED TO COVID-19:

State Labor Offices

Find Your State’s COVID-19 Employer Resource Website

ADP Employment Tax Guide: State Agency Status in Response to COVID-19

SBA Disaster Relief Loan

Disaster Relief in Response to the Coronavirus

IRS Guidance on Families First Coronavirus Relief Act

Tax Credits for Small & Midsize Businesses

Treasury, IRS and Labor announce plan to implement Coronavirus-related paid leave for workers and tax credits for small and midsize businesses to swiftly recover the cost of providing Coronavirus-related leave. Read more from the IRS…

Managing Cash Flow – Recommendations from Cain Watters & Associates

With recent announcements that effectively close dental practices temporarily for the next several weeks (or months in some states), we are all uneasy about the coming weeks. Cain Watters Associates recently shared some suggestions for Dentists regarding managing cash flow during the COVID-19 pandemic.

Will financial assistance be available for small businesses to help pay costs when no income is being generated?

Most dental associations and the ADA are advocating on behalf of the profession to seek economic relief at the federal and state levels.

Some Organizations Already Offering Assistance

U.S. Small Business Administration is offering relief to businesses impacted by COVID-19. Small Business Administration Disaster Assistance Loans will be available to small businesses that have been severely impacted by the situation. (Read the ADA article.)

Local assistance may be offered, and business owners should visit their local city or county websites for any additional relief that may be available to them.

 

Tax Assistance: Employers experiencing a hardship as a result of COVID-19 may defer Federal tax payments until July 16, 2020.

Several states have put plans in place regarding filing of state taxes and extensions.

 

Financial Institutions: Many financial institutions and student loan services are also already offering assistance in the form of fee waivers, early withdrawal penalties, deferred payments, and changes to repayment plans. Reach out to your financial institution(s) or loan servicer with questions.

Business Interruption Insurance

Be sure to check your business owner’s policy or property insurance policy. Business interruption is commonly made part of a property insurance or business owner’s policy (BOP) and if included in your policy, it pays out if the cause of loss is covered by the overarching or primary policy. Business interruption is intended to help cover a business’ lost income or revenues resulting from a disaster which causes physical damage to your insured property and loss of occupancy as a result of a civil authority mandate. It is important to note however that most property insurance policies contain a specific exclusion for disease or a virus causing agent in the policy. The ADA is advising members “to consult with their personal insurance agent representative and/or legal counsel to carefully review their insurance policies and assess what coverage, if any, may exist for potential claims arising out of the coronavirus risk environment.”

Delta Dental Member Support

DDWA is launching two programs aimed to support Member Dentists during this time – the Delta Dental of Washington (DDWA) Independent Dental Practice Reimbursement Advance Program and the DDWA Independent Dental Practice Assistance Fund. Learn more on the DDWA website.

Helpful Resources

 

Most Recent Updates

NIH Study shows Coronavirus stable as aerosol and on surfaces Visit Article (3/17)

ADA congressional lobby for relief package Visit Article (3/17)

ADA’s Statement on postponing elective dental procedures Visit Article (3/16)

 

FAQs

Based on recommendations and guidance from the CDC and the ADA, dental practices are being asked to limit patient treatment due to the COVID-19 pandemic. It is recommended dentists practicing in many states voluntarily suspend nonessential or non-urgent dental care, depending on the state. (See your state specific association or public health site for recommendations).

Why close your dental practice?

In short, to help “flatten the curve” and ensure the continued health of your patients, your staff and you. The COVID-19 pandemic is putting a strain on all health care facilities and resources locally and nationally due to the increasing number of affected individuals.

What do I tell my team?

We’d suggest verbiage similar to this: We need to do our part to help our community during this historic time. In order to ensure the continued health of ourselves and our patients, we are suspending nonessential or non-urgent dental care as recommended by the ADA, your local Public Health Authority, or Dental Association. The health and welfare of our patients, our staff, all of our families, and extended community, is our top priority and we want to do our part to limit the spread of COVID-19 and lessen the strain on resources needed to treat patients who are suffering with the virus. I value your assistance in making this a smooth transition. I appreciate your commitment to working together to get through this difficult and, hopefully, brief time.  We may be closed temporarily, but we are going to stay in close contact with each other throughout this pandemic and we will all emerge stronger because of this experience.

How long will the practice remain closed?

If public health officials see positive indications of slow disease spread and possible containment, the recommendations for social distancing may ease. Currently the shortage of PPE’s are placing a strain on the healthcare community. Oral health is important, as those pressures ease and the supply chain returns to normal, recommendations for dental practices may change. As time goes on and more is understood about the virus, such as how long it remains infectious in the air and on different surfaces, the CDC can make informed recommendations on how individuals can protect themselves from the virus. We will continue to monitor and follow recommendations and guidance offered from the ADA and our local public health departments.

Employment Questions

We continue to monitor pending federal legislation to address family and sick leave due to COVID-19 and will update this site accordingly.  The information below is based on federal laws, not your individual state laws.

 

Can I require employees to use accrued paid sick leave?

An employer cannot require an employee to use paid sick leave, that is the employee’s choice.  If an employee does not qualify for paid sick leave or has exhausted their paid sick leave, other leave may be available to them in the form of paid time off or vacation.

 

What resources are available for our employees if I can’t pay them while the practice is closed?

Partial wage replacement may be available to those employees through unemployment benefits. Additional benefits may be available through the Families First Coronavirus Response Act that was signed into law on March 18th. Access to unemployment benefits and federal relief aid are rapidly changing. Check frequently for these updates.

 

Can I lay off my employees so they can get unemployment and then rehire them?

If you’ve reduced your schedule or closed the practice temporarily, you are not required to lay off or terminate employees you intend to continue to employ. Partial unemployment claims are available in many states. The employer must often certify that the employee is expected to return to work. Several states offer a variety of options for temporary closures, standby and reduced work hours. Select options carefully as many have strict stipulations.

Alaska

Arizona

Arkansas

California

Colorado

Idaho

Kansas

Missouri

Montana

Nevada

New Mexico

Oklahoma

Oregon

Texas

Utah

Washington

Wyoming

Contact your State Labor Office

 

Where Can I Find My State’s COVID-19 Employer Resource Website?

Make sure you know the latest coronavirus-related guidance issued by your state, including public safety mandates, agency closures, and the latest local labor legislation. Here’s a table to reference for guidance by state.

 

ADP Employment Tax Guide

State Agency Status in Response to COVID-19

 

How do I notify my appointed patients of the office closure?

Contact patients via phone, email and text and reschedule their appointments for a later date. Explain the reason for the change. Here is a sample closure announcement and message for your confirmation system. Make sure your patients know that you will be available for dental emergencies throughout the temporary closure.  It is important your patients know you will be there if they need you while reducing the potential strain on emergency rooms.