How to Create a Resilient Practice During Tough Times

Ron Perry, DMD, MS, and Lori Trost, DMD
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More than ever, dentists are wondering what they can do during this downtime. Now is a good opportunity for themto implement ideas that will help sustain their practices, involve team members, and engage patients. It also is an opportunity for dentists to review patient protocols and how to leverage technology to their advantage.

Where Things Stand 

On March 27, the Centers for Disease Control and Prevention (CDC) issued a statement recommending that dental facilities postpone elective procedures, surgeries, and non-urgent visits and prioritize urgent and emergency visits. This recommendation mirrors the guidance from several oral health organizations and regulatory bodies.

The ADA recommends that dental offices only treat urgent and emergency cases through April 30. The Massachusetts Dental Society (MDS) recommends keeping dental practices closed to elective and non-urgent care through May 4.

It’s unclear just how many weeks the CDC anticipates its recommendation to be in effect. The MDS Board of Trustees, for example, will be reviewing the CDC’s recommendation to determine if the timeline for the MDS’s previous guidance on office closures should be extended. The MDS will update members as soon as possible. 

The CDC also urged dental and medical providers to work together to determine an appropriate facility for treatment of urgent clinical care of patients with known or suspected COVID-19. Providers are urged to follow the CDC’s Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings.

What You and Your Staff Can Do 

Here are some projects that you can start to help ensure the viability of your practice during the pandemic: 

  • Establish and forecast your financial position
  • Re-issue credit cards
  • Negotiate leases, rent, and any payables
  • Create a specific account for COVID-19 expenses.

Here are some tasks that you can rotate among the members of your team to keep your practice going during the shutdown:

  • Reassure your patients
  • Answer the phones
  • Set up emergency appointments
  • Audit charts, insurance, and treatment plans
  • Perform updates and other maintenance on dental equipment
  • Reorganize the office
  • Disinfect the office
  • Update the practice’s website
  • Create an office protocol of do’s and don’ts

Together, the dentist and team can learn how to use technologies such as video, texts, and other touchpoints. Weave lets team members stay in touch through private chat. Zoom, Apple’s FaceTime, Gotomeeting, and Google Meet enable online team meetings and training. This technology can be used to set up face-to-face time with patients for dental triage and virtual hours as well.

Downtime is an additional opportunity to engage in online continuing education and revisit all protocols such as emergency protocols, patient pre-screening, and payment solutions. New office protocols should be developed as well, such as how a graduated re-entry of patients will look. And, of course, safety should always be the top concern.

The CARES Act 

Dentists should explore what the recently passed CARES Act can provide them. It includes a paycheck protection program, emergencyEconomic Injury Disaster Loan (EIDL) grants, delayed payroll tax payments, recovery rebates for individuals, enhanced and expanded unemploymentbenefits, and policies affecting retirement, student loans, charity, depreciation, and state loans. 

For example, businesses with fewer than 500 employees may obtain a Paycheck Protection Program loan based on 2.5x their average payroll per month and use it for payroll-related costs, rent, business mortgage interest, and utilities. To the extent the amount is spent on those items in the eight weeks following receiving the loan, that portion of the loan will be forgiven.  

Dentists can obtain these new Small Business Administration (SBA) loans through local banks once in effect and must keep documentation that the proceeds were used for the allowed purposes. The amount of loan forgiveness will be reduced if the number of employees or weekly payroll has been reduced. 

This loan program is a substantial benefit. But to maximize the loan forgiveness, dentists need to obtain the Paycheck Protection loan prior to paying payroll. If you are open on an emergency basis only and your wages for the next eight weeks will be 25% of what they were in 2019, you may only receive forgiveness on 25% of the loan.  

If you use the loan to pay all your employees during a shutdown period, you won’t have it available as working capital when your business is back to normal. To maximize its benefit, you may want to apply for the loan when you are ready to pay payroll for your full staff. Also, you are not disqualified from this loan if you are in the process of getting an existing SBA or state loan.

Also, EIDL grants are advances on loan applications of not more than $10,000 that can be used for payroll, business loans, and other obligations that cannot be met due to revenue losses.

Payments of the employer portion of Social Security taxes will be postponed until December 31, 2021, and December 31, 2022. Dentists will need to work with their payroll companies to properly administer these payments. 

Essentially, these postponements are interest-free loans. To make sure you can take advantage of them, use a full-service payroll company such as Connectpay, ADP, or Paychex if you haven’t already because of the difficulty in implementing this delay and other changes.

Recovery rebates will be available as well, as individuals receive $1,200, married couples who file jointly receive $2,400, and dependents receive $500 as an advanced payment of a 2020 tax credit. The credit will completely phase out when 2020 adjusted gross income is $99,000 for those filing singly or $198,000 for those couples filing jointly.

Many practice owners won’t benefit from this rebate. But their employees will, and it will be helpful in providing them with liquidity, just as the other relief elements will help practices. 

Enhanced unemployment will allow individuals collecting unemployment to receive the normal allowed amount, plus $600 per week.If your employees are collecting unemployment, this will provide additional financial relief and help ensure they are financially able to wait out the office shutdown. 

Self-employed individuals will be eligible for unemployment, including sole proprietors, partners in partnerships, and 1099 associates. If you aren’t eligible to receive a W-2, you may not have been previously eligible for unemployment.

Taxpayers don’t need to take a required minimum distribution from an IRA in 2020. Taxpayers affected by COVID-19 may withdraw up to $100,000 penalty-free from an IRA and spread the income over three years. They may repay the balance within three years and treat the distribution as a 60-day rollover. Guidelines will be issued to further clarify eligible reasons for distributions. 

We urge practices to use other available loans to meet liquidity needs. However, if you need to draw money from an IRA, this program enables you to meet short-term obligations and then put the money back into retirement once you are able to.

In 2020, employers may reimburse employees up to $5,250 for student loan repayments and not have it be taxable wages to the employee. In addition, payments are not required for federal student loans until September 30, 2020, and there will be no accrual of interest. You can use this as a recruitment or retention incentive in 2020 with associates or other employees.

Plus, you can make a $300 above-the-line charitable deduction. You won’t need to itemize to realize this benefit. And, qualified improvements (eligible leasehold improvements) will be depreciated over 15 years instead of 39 years and eligible for bonus depreciation. 

Unrelated to the CARES Act, some states such as Massachusetts and Connecticut have made their own loan programs available. These funds are being used up quickly, which is why we recommend using the federal benefits. 

Dr. Perry is a professor of comprehensive care and director of the Dental International Students program at Tufts University School of Dental Medicine. He can be reached at ronald.perry@tufts.edu.

Dr. Trost received her dental degree from the Southern Illinois University School of Dental Medicine. She maintains a private practice in the Greater St. Louis area. Dr. Trost offers postgraduate courses to dentists and their team members that draw from her extensive private practice experience and focus on restorative dentistry, digital technology, dental materials, orthodontics, business management, and patient communication. She is an author, clinical evaluator, and editorial board member and is listed as one of Dentistry Today’s Leaders in Continuing Education. She can be reached at trostdental.com or via email at trost@htc.net.

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