One of the many weird things about COVID is the loss of the sense of time.  If your Monday through Friday work attire looks a lot like what you wear to mow the lawn on Saturday, it is hard to remember what day of the week it is.

If bathing is now somewhat random, well, just keep that news to yourself.

It is not only the days of the week that get blurry, but the passage of time is as warped as a Dali clock.   Have we really only been in this thing for five months?  It seems like five years.

Way back in March, back when the government showed up at the scene and started spraying money like water on a fire, our sense of future time was best characterized as ‘temporary.’  Survive a couple of months, get to Easter, or at worst, the 4^th of July, and then get back to the election or football or whatever your late summer pleasures.

Well…

Two of the primary injections aimed at small business in general and healthcare providers specifically – the PPP loan/grants and the advance Medicare payments – served their purpose to avert immediate disaster. But both were clearly conceptualized in the hopeful framework of the day that this all was temporary.

Well…

The PPP money is running out and those Medicare advance payments were a payday advance. Without some additional Congressional action, CMS will soon begin recouping those payments by applying the amount due against new claims.  See here.

Let’s translate that: If you took the advance payments them the claims you are about to submit are not going to get paid but will instead be applied to your ‘loan.’

Now to translate the translation: If you spent that money to survive the spring and summer, which was the plan, and if you are fairly dependent on Medicare, well dang, your cash planning is again about to get pretty binding.

I am not throwing stones at what the government did – we really had no choice – but temporary solutions for what is turning out to be a much longer-term problem leads to one unavoidable conclusion:

Zombies

Not what you thought I was going to say?

It is sad, but it is true.  Many companies are already gone and there are many more that are dead and just haven’t fallen over yet, but soon will.  The math is inevitable.  Healthcare and physician practices are not immune to the economic gravity.

Mr. Sunshine today, huh?

First, I hope your practice is not a zombie.  Because unlike in the movies, they really are dead.

Second, and I realize I sound like a greedy pig in saying this, but when companies finally give up the ghost and keel over, there is opportunity for someone.  So, if you are not among the walking dead, be ready to move quickly into the soon to be vacated space because others will be.

I confess that I enjoy the distractions from real life that sports bring, but COVID has me a bit conflicted.  If ever we needed some mindless stuff to talk about that aren’t so heavy, it is now.  Loving or hating the Yankees or Cowboys or Lakers would be a relief.

Then again, it is sports we are talking about, not people dying; or caregivers who sleep in the basement to protect their families from the risks of their job; or the one in five people who are unemployed; or the 100,000 small businesses that may close forever.

But these are people and businesses and universities, too.

It makes my head hurt trying to decide if I am for or against.

That said, they are trying to make it happen and since they are, there is an analogy I want to steal.

In major league baseball, the trade deadline generally comes around late July, after they have played about four months.  Teams that have a chance of making the playoff are ‘buyers;’ those who are out of it are ‘sellers.’

What that means is that buyers trade the future – young prospects – to the sellers for players in their prime who can help them win now. General managers look hard at their team and decide if they should be buyers or sellers.  In this COVID-shortened season they will, virus willing, play only a third of the normal games, so the trade deadline comes quickly.  The decision to trade or hold will be even trickier, but no less important.

COVID may have shortened the baseball season, but the pandemic season just seems to be lengthening day by day.  Little did we know that ‘by Easter’ meant Easter 2021.  Physician practices, like every other business, may not be able to count on the quick return to normal strategy.  As such, it may be time to lean back in your chair and ask, ‘Am I good with our situation, our prospects, our chances…or should we be buyers or sellers?’

In the recent physician survey published by McKinsey and Company that we referenced a couple of weeks ago, half of the independent physicians were more likely to consider an employment option than they were pre-COVID.  I get it.  Getting to a safe harbor now might cause you to tolerate more employment hassles than you would have in the past, though it is worth noting that being employed by a health system did not, is not, may not provide as much security as you might have imagined six months ago.

Conversely, only one in four was more likely to think about partnering or selling now.

Let me encourage you to consider that option a little more.  Maybe it is time to be a buyer, or a seller, or both.  Maybe this is better than standing pat or just throwing in the towel and taking a J-O-B.

Times like can lead to some moves that create a much better future scenario.

My home state of Colorado boasts of 53 14ers, mountain peaks that rise above 14,000 feet.  Or maybe it is 58 if you don’t get too technical about how deep the saddle must be between peaks if you want to count them as two instead of one. If you schlepped up there and hit both peaks, count however you want.

For many, collecting 14ers is a life-life pursuit, a badge of honor. My buddy is on a similar mission, trying to see how many of our state’s craft beers he can drink.  Some people do both.

Rookie climbers experience the psychological letdown of ‘false summits,’ that belief that you are almost there, only to get to the top of a peak you’ve been eyeing and discover that there is more mountain – sometimes a lot more – left hiding behind it.

You are tired, your friends who told you this would be fun forgot to mention the blisters or how heavy a backpack starts to feel after a while, but you see your goal and trudge on.  Then the goal is a mirage that mocks you as the trail continues to ascend to the sky.  The real summit is still ahead, or is that another fake one?

I do have one piece of advice for first time hikers from the flatlands, wanting to come to Colorado and bag a 14er for bragging rights back home – take on Mt. Evans.  You can drive to the top and the parking lot is about 100 feet from the summit.  You don’t have to give all the details when you get back.

But like the hiking, the pandemic come with false summits and those can bring disappointment that must be managed, or it turns into discouragement.  That is a battle some of us are facing right now.

Like tired kids in the back seat during a cross-country trip, some are starting to whine, ‘Are we there yet?  When will this be over?  When will things get back to normal?’

It is a fair question, but repeatedly setting false milestones in this time can do more than lead to disappointment – it also offers a way out from having to face some really hard questions.

If there is a summit, a real one – this one or the next one, that implies, like hiking, that we eventually get to the top, take a selfie, turn around, head down, then resume our beer quest.

But COVID will not work that way, at least not entirely.  Some things are changed forever.

So, time for a hard question…is your hope for a return to normal just a way to avoid facing some hard decisions that you need to make to put your practice in position to be healthy in the future?

Sit atop a mountain peak (or just have a craft beer) and ponder.