Reopening Your Behavioral Health Practice During COVID-19

Mental health professionals are considered essential, which means you can already see clients in person with the proper protection. But, should you? And if so, when and how should you make this change?

As many states ease restrictions on what businesses need to stay closed to prevent the spread of COVID-19, many in our field are looking to ditch the screens and phone and start seeing clients in person again. But with so little understood about the prevalence of COVID-19 is and how it spreads, reopening is a decision that could put providers and clients at risk if it’s not done with careful planning and sufficient safety measures.

As you think over reopening your mental health practice, here are a few things to consider:

Should you reopen your practice’s physical location?

The first thing you should consider when you think about reopening is: Should you reopen at all? Some clients would certainly benefit from in-person sessions. For others this new telehealth paradigm might work better. So what does re-opening in a mid- and post-COVID19 world look like?

Clients, providers and staff safety are the most important considerations, and communication is crucial. If the majority of your therapists and clients are comfortable continuing to conduct sessions via telehealth, maybe it’s best to continue with that as long as possible and leave your physical location closed. This is easier right now considering that most payers have temporarily revised policies to allow for telehealth, and CMS has relaxed restrictions on using platforms like FaceTime, Zoom and the telephone.

But if you decide to re-open, even with limited clients and staff, you’ll need to answer a few important questions.

How will you maintain social distancing with clients?

Unfortunately, every interaction with a client presents an opportunity for you, your therapists or the clients to be exposed to COVID-19. And while it may seem simple to make sure everyone stays six feet apart, Business Insider points out that it may not be as easy as  you think.

Here’s what you need to think about to keep these interactions safe:

1. How will clients safely enter/leave the practice? The US Chamber of Commerce spoke to a massage therapy business that requires clients to call the receptionist before entering the practice to help reduce how many clients are in the lobby, a model that could work for solo and group practices. If you have a group practice, you could also consider staggering ’ appointment times if you’re a group practice (i.e. Therapist #1 starts appointments on the hour, therapist #2 starts 30 minutes after the hour) so that clients aren’t in the lobby at the same time. You should also consider how you will reduce face-to-face contact between your receptionist, if you have one, and clients.
2. How will you set up individual offices to promote social distancing between the client and the therapist? Can you rearrange or remove furniture to keep everyone at least six feet apart? If not, the Telehealth Behavioral Health institute suggests setting up plexiglass shields as an option that may or may not work for your staff and clients.?

How will you disinfect your practice?

Disinfecting your practice is an obvious measure to take to prevent the spread of COVID-19. Some important elements to consider when deciding how to disinfect your practice are:

1. What needs to be disinfected? It’s not practical to frequently disinfect every surface in your practice, so make sure to identify high-touch surfaces to clean frequently.
2. How often will you require these surfaces to be disinfected?
3. Who will be responsible for disinfecting? If you’re a solo practitioner, the answer is likely you. But if you’re in a group practice, will the therapists be responsible for their own offices (and if they’re independent contractors, can you legally require them to do that)? Who will disinfect shared spaces like reception areas and lunch rooms? Do you need to hire a service to do this?

The CDC has detailed guidance for how to disinfect your business here. Check it out as you make your plan.

How will personal protective equipment (PPE) be handled?

PPE, like surgical masks, is an incredibly important measure to prevent the spread of COVID-19. While Forbes states that most employers are not required to arrange for PPE to protect workers from COVID-19, providing it could be extremely helpful to keep your therapists and clients safe.

When thinking about PPE and your practice, you need to consider:

1. Will you require all clients to wear PPE? If a client refuses, how will that be handled?
2. Will you provide PPE to your therapists? If you do, you need to identify a reliable supplier to make sure you don’t run out.
3. In many cases, OSHA requires that employers pay for PPE. How much will this cost your practice, and will that outweigh the benefits of reopening?

How will you communicate these measures to your therapists, staff and clients?

Deciding on these measures is important, but how you’ll communicate them with your therapists, staff and clients is equally crucial.

First, consider how you’ll get the word out to therapists and staff. Will you hold a staff meeting (remote or in person) to go over these measures and take questions/comments? Will you provide training on how to properly use PPE, and will you require a written acknowledgement of these new policies?

Also consider how you’ll communicate these measures and requirements to clients. As an ice cream shop in Massachusetts discovered, customers who are uninformed about social distancing/PPE measures can cause a dangerous and frustrating situation. So, will you send an email to all clients with these requirements? Will your therapists reach out to their clients individually to confirm that they understand what’s required when they visit?

Finally, consider screening every client directly for symptoms or contact with people who have had COVID19 or COVID19 symptoms before seeing them in-person. Front office staff or providers can accomplish this by going through a series of questions with the clients or having them complete a questionnaire about symptoms or contact. Here’s the CDC’s symptom list.

The bottom line is: Now may not be the time to re-open your practice to in-person therapy, but at some point soon it will be. To be successful and safe, you need to think it through carefully; make a plan for how to keep yourself, your therapists and your clients safe; and communicate this plan effectively to staff and clients. If you’re looking for a place to start, the Minnesota Department of Health has guidance for how to safely return to work and a template that you can use to inform your own plan.

If you decide that telemedicine is a good alternative to reopening your physical location, check out our guidance for how to bill insurance companies for telehealth. Our revenue cycle management team has been on the phone with payers for months gathering information on which insurance companies reimburse for telehealth, what codes you need to use to make sure your claims are processed, and much more.