Rachel K. Downey, MHA, is an Administrator at Dermatology Associates of Virginia where she has worked for more than six years. Founded in 1969 by Richmond native Charles M. Caravati, Jr., M.D., the practice has grown to 16 Board-certified physicians and four mid-level providers practicing at six central Virginia locations with a goal to excel in quality, patient experience, and cost-effectiveness.
Rachel handles the business and financial oversight for six clinics and 21 providers and credits a great team of administrators and clinicians for the day-to-day operational management. She has 28 years of experience in healthcare. Before joining the dermatology group, she spent 17 years in management at a pediatric practice, and prior to that, she worked for a health system. She completed her master’s degree in Healthcare Administration and is a Certified Member of the American College of Medical Practice Executives (ACMPE).
Like everyone else in healthcare, Rachel has weathered the COVID tidal wave, adapting to the “new normal” over the past 18 months, and said it has been a continuous adjustment.
When the pandemic hit, she was away on vacation in Spain, visiting her son who was studying abroad. She flew home on the day of the international travel lockdown and had to quarantine for two weeks. She worked remotely during that time but says it was a non-stop struggle to try to manage through that time.
“I came back to a 24/7 effort,” she said. “We were constantly fielding emails, holding conference calls, watching the news, governor advisories, attending webinars, and trying to figure out what was going on.”
Their patient volume was drastically limited, like most physician offices at that time, and when the state of Virginia mandated that medical needs that were not critical or urgent be postponed, they started the process of rescheduling routine care, and shifting to virtual visits when possible. They wanted to do the right thing for their patients and staff to keep going. Fast research got them up and running quickly, avoiding a lengthy ramp-up.
“We stayed open to see patients, but shifted a lot of it to telehealth, which we had never done but somehow managed to implement within five days,” she said.
The practice operates a small surgical suite that remained open for visits and procedures that could not be postponed such as skin cancer follow-ups or emergent situations. A great clinical operations team helped keep things rolling. They kept all six offices open with PPE and social distancing but had to temporarily furlough some of the staff.
“We helped staff get unemployment benefits, and we received Paycheck Protection Program (PPP) business funds awarded by the government, which was extremely beneficial, and took a huge weight off our shoulders,” she said. “Once we figured out how to do safe routine visits with protocols in office, we’ve been fine volume-and stability-wise. Our specialty has more demand than access. People wait to get appointments.”
Because their specialty is not hospital-based, they haven’t had as many stressors as other specialties.
“Financially, we are doing fine right now, but it definitely helped us early on having that PPP money. We were able to keep all workers with no permanent layoffs.”
Things got better in the state in June 2020, and Dermatology Associates reopened all its locations to routine care. A new online patient intake system helped cut down wait in-office wait times. Rachel said they have started to catch up, but there are still issues they grapple with.
“It feels like we’re going through it all over again. Over the past month, there have been more decisions to be made about staffing, PPE, and dealing with patients that don’t want to mask up in the practice.”
Like everyone in healthcare, Rachel pushed to meet the patient and organizational needs during the crisis and credits her education, experience, and network for helping her to act fast throughout the pandemic.
She said that during a crisis, whether in a hospital system or primary care, you gain different types of experience. Their specialty is not hospital-based so their stressors were different from those in other specialties.
“One of my first mentors said that to be successful you must be able to act fast, flat, and fluid; fast – meaning you must be able to react to things in a timely manner, flat – be fiscally efficient, as in not having a lot of unnecessary expenses, and fluid – adaptive when you need to change course.”
But her undergraduate degree in psychology, she jokingly says, is what helps her through.
“I use it daily dealing with different personalities and reactions to stress. I always wonder if I’m doing a good job. We all wonder, are we as effective as we could be? I think if you feel like you have all the answers, you probably don’t. It’s human nature to question if you’re doing the right thing.
We have a strong group of healthcare administrator groups in our market. Some through the Virginia State Medical Society, ACOs, local and state MGMA organizations, and contacts that I’ve connected with over the years. We helped each other get through the last 18 months. Those contacts and network are invaluable.”
Time management skills also helped her through and says she lives by her Outlook calendar. She fits in professional reading weekly.
“I try to block off time each week to work on the most important things I need to get done. Pop-ups are good, but I’m also a firm believer in turning it off so it’s not overwhelming. I always answer texts or phone calls after hours, but I don’t check my work email after hours. I need time away to regroup.” During the two weeks in quarantine, she couldn’t turn it off and found it difficult to work from home for that reason.
When it comes to continuing education, Rachel prefers live, physically present over virtual learning.
“I participated in two virtual conferences this summer. Even though I have access to the recorded content, I’ve only watched one session.”
She said they still need resources and help. Every cog in the wheel contributes to provider effectiveness and the bottom line, whether they are helping patients complete an insurance form correctly, coding/auditing charts, fighting claim denials, etc.
“I think that getting everything correct on the front end of the visit is imperative. This sets the course for success for the practice as well as the patient. If there is an error in registration, it can lead to delays in payment to the practice and potentially misbilling patients. Even if a patient has had a wonderful clinical experience with your practice that can be quickly overshadowed when they are later faced with an unnecessary bill. 'Do the right thing, at the right time.'
I also strongly encourage being tenacious with the payers. Don’t trust that their adjustment or denials are correct. We are constantly working on holding payers to their contracts.
With regard to COVID-19, there are still so many other things going on that we don’t normally have to deal with it. It’s unfortunate that we’re not seeing light at the end of the tunnel.”