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 Tools for Navigating COVID-19 Uncertainty in Infusion Centers Transcript, Part 2

HOST:I’d like to welcome you to today’s webinar, Tools for Navigating COVID-19 Uncertainty in Infusion Centers, presented by Ashley Joseph, senior director of client services, and Helen Liu, product manager.

ASHLEY JOSEPH: Thank you so much, Josephine. Welcome everybody. I am absolutely thrilled to be here with you this morning. We had over 220 people registered for this session. And it looks like we’ve got a large chunk of those already here. I’m excited not only to share with you what we’ve been doing at LeanTaaS, but also to hear from you in the Q&A session about things that are on your mind, and get a sense of– just take the temperature of the infusion community overall. We’re going to share some facts and figures with you before we move into the tools. And I just wanted those of you who are not familiar with LeanTaaS to know where the data comes from. We work with over 200 infusion centers around the country, and those represent about 78 hospitals or hospital systems. And over the last few weeks, we’ve had a lot of conversations with most of those centers, including many of you that are on the line now, to hear about what you’re experiencing, as well as to help with specific analytics and things that folks have been contending within their individual centers, and trying to help folks manage those things. So I just wanted to give you a bit of a sense of where our data is coming from, both the qualitative and quantitative data. So we know that you guys are living right now in this covered world in infusion centers. So on one hand, talking about the impact of COVID-19 on infusion operations feels a little silly. But we’ve also heard, over and over again, people ask what are you hearing elsewhere. So we wanted to take a couple of minutes to just show you some of the trends that we’re seeing in some of the rolled up data to give you a sense of that. Then we’re going to spend the lion’s share of our time talking about your actual recovery strategy, and sharing the specific pools that we’ve developed that– develop not just for our customers by the way, but for anybody. We’ll make all of these tools available to everyone for you to use in your own recovery strategy. And then we’ll make sure that there’s plenty of time at the end for Q&A. So, impact on infusion centers. So what you’re seeing here is roll up data for about 170 infusion centers across the country, and March 16 was the day. That was the day that we started to see a statistically significant decline that was maintained across the average of centers as we look at volumes. So the average decline in volume in an individual center was about 13%. We’re going to talk about some of the distributions a little bit later. But in general, most centers that we’ve talked to and we’ve seen , have suffered declines between 5% and 35%. We think that that decline is due to several things. And obviously, it’s due to COVID-19. But we’ve tried to get down into the details and understand the very specifics. So we think that a huge chunk of it is a reduction in new cancer diagnoses. So we have delays and cancelations of surgeries, of screenings, colonoscopy, mammograms, that sort of thing. So the reduction diagnoses certainly has an impact. A lot of deferred and canceled treatments, especially ones that could be pushed out, have been pushed out. We’ve also seen, in this category, quite a few new starts that have been I– have been delayed primarily because of immunosuppression risk that comes with the particular chemo that was ordered. By the way, there’s some hypotheses about where some of that volume may have gone. And I’d be interested to hear your thoughts on that. Social distancing requirement. So for those patients that are still coming into the center, they’re having to be spaced farther apart, which especially in centers that have open bay arrangements. This is leading to fewer chairs being available at any given time. The other thing that we’re hearing is that it takes a lot longer to turn a room or to turn a chair because of the EVS sorts of requirements there, which also reduces the volumes that any given center can have. And then we’ve seen conversion of some treatments to home infusion, to supportive treatments only. Those were the things [INAUDIBLE] that. And we know that some of those will come back, and some of them will not. And that’s something that we’re going to talk about a little bit later. So in terms of other trends that we’ve seen, as I said, the average volume decline across all centers has been about 13%. Approximately, 80% of infusion centers saw declines between 5% and 35%. So that’s been the typical. Now, there have been some outliers on both sides actually. We’ve seen some larger declines including quite a few centers that have gone to 0% in terms of having volume because the space has been overtaken for another purpose during this time. We’ve also seen a few centers that have actually increased volume during this time. And in almost all cases, those two things the 0% and the over 100% numbers are related. It’s like pushing on a balloon. So we would have seen one center go to zero volume, and another taking some of that volume. However, One plus one has not equaled two. Instead, we would see that both centers that were combined reduced. But once center would appear to have over 100% of volume. So there’s a little bit of stuff going on behind the scenes in those that. Most centers began to see declines in their daily volume about one week prior to their states issuing of shelter in place order, which makes sense given the population that we serve. And then there was a difference across regions in terms of overall average decline. The Northeast certainly was hit the hardest. And we see the biggest declines there. And then it was a little bit more consistent across the West, the Midwest, and the South, in terms of declines that we’ve seen. We like to look at the types of appointments that are being booked as well as the lead time. And what we’ve seen during this period is that new appointments are down. But the new appointments that are being booked tend to skew heavily towards short lead time appointments. And we also look a lot at linked and unlinked appointments in terms of whether or not there’s a clinic visit linked. And we’ve seen that link and unlink appointments have also been affected quite differently during this time with the volume of linked appointments decreasing much more than unlinked appointments, and also skewing much more towards shorter lead times. It’s important to note that when I say that they’ve skewed this way, we’re talking about a skew versus what we would typically see in the data, not necessarily in absolute terms. So these last two bullets are actual changes that we’ve seen in the world of volume, and how we see the volumes typically come through. It would be great if you guys would share with us a little bit what you are seeing in terms of the volume declines and volume trends. So I want to throw a poll up here. And it would be great if you could just take a second, and let us know at your center or centers, what have your overall volume trends look like? I know some of you represent many centers, by the way, make your best guess. Give you guys couple more seconds here. We’ve got about 50% of respondents at this point. I am going to share the results by the way, so that you guys can see exactly what your peers have experienced over this time. Anybody else? Again, make a quick guess, if you need to, about where you have been. All right. So here is what we see. You guys should be able to see the poll numbers here. And it looks like your poll data is extremely consistent with what we’ve seen across the country. So about 50% of you are experiencing between 5% and 15% volume reduction, about a third of you are experiencing 15% to 25%. And then, as usual, and as expected, we have some outliers that are, again, in close proportion to what we’ve seen in the rolled up data. So this is very helpful to us to get a sense of how much validity there is in our data. And this is very encouraging. So thank you guys for taking the time to do that. By the way, we’re going to have a couple more polls as we go through the day. And we really do appreciate your giving us feedback through those. All right. So we think that this is what is coming next. All right. So we think that the next iteration of this is going to be exactly the opposite of what you have dealt with today. So we’re going to build this slide here. If you take this dotted line here and assume that this is an average volume in a typical data center, we’ve seen a reduction in the various types of– and we’ve only put a couple here– in the various types of appointments that you have. And so what you have experienced over the last little while is this decline phase that we just looked at the poll. Of this volume that you’ve reduced, that this would be the absolute amount, but a huge chunk of that is what we’ll call deferred volume. So that is volume that you will eventually get back, either because treatments that have gone out of house will move back in-house. New starts will happen. All of those drivers that I talked about that have caused the volume decline will reverse. But there will be some that will be this unrecoverable loss. And the unrecoverable loss bucket is going to be things like treatments that move out of house that don’t come back in-house, treatments that became palliative care because they weren’t able to deliver the treatment. In some cases, the patient may have gone elsewhere because they were able to get treatment that was not being offered in a particular center. For all sorts of reasons, there will be some piece 234 00:10:28,930 –> 00:10:30,220 of this that is unrecoverable. So most of you have been dealing over the last few weeks with this deferred volume piece. We think, though, that this whiplash is about to happen, and that is when you’re going to get this surge. So you’re going to have the volume that you would typically have on a daily basis. But then the deferred volume this red part, is going to actually come back. And it’ll come back at various speeds, depending on where you are. We’re going to talk about that in depth soon. But we do think that this surge is coming. And so this will be your business as usual volume, plus your deferred volume. That’ll leave you with these volumes on the side, which are much higher. And you’ll see an expansion in each one of these categories. | so for all of you who are listening right now, what you are probably trying– you’ve probably figured out how your COVID world is going to look. And now, you’re probably starting to think about what exactly is going to happen here, and how do I plan for it, how do I get the numbers right, how do I model scenarios quickly and efficiently, especially given how the news seems to change on a day-to-day basis. So we think that these are the sorts of things that are on your mind right now. How can I recover faster? How can I do it in the least painful way for patients and staff? Hopefully, these are, in fact, the questions that are on your mind. And the good news is, is that it’s actually pretty easy to answer these questions. All you need to do is do a little bit of math. So here you see a very simple way of tackling this problem you can see all of the intervals. And you can see all of the equations that drive this thing. So if you start to put your numbers in, then you can very quickly create this. Now, guys, I’m just kidding. I’m not going to ask you to do this math. The good news is, is that this is the math that we’ve already done. So this is the math that we’ve done for you. And this is the tool that we created so that you won’t have to do all of that math, and pull out your child’s algebra or calculus textbook in order to plan your own recovery. And we’re going to talk about that in just a minute. But let’s go ahead, and shift gears for a minute to planning your recovery strategy. This is the part that we imagine is probably keeping you up at night these days. And fortunately, we’re going to offer up a four-step way to start planning your recovery. The first is going to be to determine your estimated backlog and calculate your recovery date. I’m going to turn it over to Helen in a minute. If she’s going to share a tool that we’ve developed it’s going to really help you with that. Second, once you know what those numbers look like, and you have aspirationally figured out what you would like them to look like, which the calculator will also help you do. You’re going to be able to look for ways to change your curve. We’re going to talk to that in some of the ways that you might do that. Then we’re going to look at some of the best practices in change management in terms of executing as one team. And then, of this last bullet point, certainly, you always want to measure iterate and innovate. But we really believe that in this post-COVID time, 309 00:13:21,990 –> 00:13:22,950 it is coming. That there is going to be some things that we really want to focus on, that are a little different than the typical way that you would do it, try to fix it in a new fusion center. So with that, I’m going to turn it over to Helen to share a little bit about the actual recovery tools themselves, and give you guys a sense of what we’ve built, and what we have available to you to help you through this.

HELEN LIU: All right. Thanks, Ashley. So you guys might have seen in the Zoom chat. I just put the link so that you guys can actually follow along while we walk through this tool. Let me share my screen here. So I’ll be giving a live demo of how to use this. Again, follow along on the Zoom chat. I’ll be going through the inputs, what they mean. And you can type in the values for your center. So again, I want to say that please use a modern browser like Chrome. I’m using Safari here. And also, you don’t have to be an iQueue customer to use the tool. It’s freely available to anyone on the web. If you have questions, we’re here to help answer them. OK. So hopefully, everyone has been able to click on that link and get into what we see here. lay out of this is really the inputs are on the left. The output is on the right. So it’s quite simple. And I’ll show you what the result is. So we’ve entered in some default values for our sample infusion center here that is being affected by COVID. And what this model tells us is the size of a backlog that you’ll be accumulating, and how long it would take for you to recover all of those appointments that you’ve accumulated during that backlog. So the way that you can read this chart is the graph shows you how to get there. So the black line is the recovery line starting at when your first saw volume drops and when your recovery can begin. And this green dotted line is about how the path of a recovery will take. So in this default example, we’re seeing a backlog of about 2,000 appointments– 1992 appointments, 2000. And we’re seeing that the green line goes to zero around mid-September 2020. So let’s go back. How do we actually get here? So the inputs are on the left, and they’re really broken up into about five different sections. So first, we want to know a few details about your center. We need to know your timeline for COVID-19. So when you were impacted. And then the volumes that we’re estimating were really breaking it two specific parts. One is about new oncology patient. And one is about the existing volume. But if a sensor has more new oncology patients, this could have a bigger impact as the faucet is turned off. OK. So let’s talk about how to populate these values one by one. So for infusion metrics, pre-COVID, what were your typical weekly volumes? You guys probably have a good sense of this. So I put 500 here. My center sees about 100 appointments every weekday. And then the next question is about the percentage of your infusions that are oncology. So 75% is a pretty typical number that we see at most infusion centers. So the bigger this number, the more the impact on your volume decline as the faucet from the oncology patients is turned off. And then finally for dates on how COVID-19 is impacting your center. So we are asking for the first day that your centers started to see the volume decline, and what that volume decline was. And then for the other timeline parameters, we’re asking for the first and last week of a shelter in place in order to predict the date that you can begin your recovery and return to normal. So our default logic here is based on what we see in the data. Shelter in place guidelines are pretty consistently correlated to volume drops. Usually, the volume drop is about one week before shelter in place. And that was something we observed across all 200 of our centers. So we’re hypothesizing that this timing on the other end of it might be reflective of that. But we know that there are a lot of different models floating around there. So you have the flexibility to enter any date you choose here. And you can always come back and update this date as you get more information. [INAUDIBLE] date picture here. If there is a certain result from a model that you haven’t helped, you can go ahead and enter right here. And then this is for information on how to estimate that backlog from new oncology patients. So as that faucet is turned off, how will that impact that backlog? So we do ask if you know what date you’re oncology clinic volume started to decrease. What we typically see is that it is usually around the same time that your infusion volumes decrease, but maybe a little bit later. And then we also ask for the percentage of new offices that have been deferred. So if you don’t know this number, that’s OK. It does take real data to calculate. But we’ve gone ahead, and repopulated this with the average that we’re seeing across all our centers. Our average is actually 61%. But you can leave it here if you don’t have an easy way to calculate that. And then just to estimate a little bit of loss in the model as well. So some of these new patients that would be deferred, you may expect to not return in a timely fashion. So we’re estimating that there will be some permanent law to do that. And we will not include that as part of the recovery. And then for patients who are already existing in the system, we know that some places are already keeping track of how many patients were deferred total. So if you know that, you can go ahead and enter that here. Otherwise, you might have a sense for what percentage of total appointments you did need to defer and move to a later in the schedule. We went ahead, again, and populated this with the average that we’re seeing across all centers, which is about 20%. And we know that of these appointments that were already scheduled, some of these patients use the home infusions for now. Some of them move to oral oncolytics. So is there a portion of these patients again who should not be included in that recovery? And we’ve estimated about 30% here. And then the final section, these are the levers that you can adjust to tweak how your recovery will actually look. So the first question is about how much additional weekly volume you would be able to add without changing any of your baseline operations? You might be thinking, well, how would I even calculate that? So one easy way might be to think, well, how many nurses we have a day? What is in this post recovery period where things are going to be busier? You’re going to have a surge, and each nurse can take one additional appointment per day. Let’s say, you have 10 nurses. Well, then, that’s 10 nurses, times one appointment a day, times five days a week. So then that’s how I got 50 here for my sample center. And then you probably know how many infusion chairs and beds are used by your center on a regular basis. We’ve heard from some of our centers that they’ve been able to borrow chairs from other departments to help with that surge. So you can see what the impact is if you have 40 chairs. Or if you’re able to borrow five more chairs, how does that affect your total timeline? And then we also ask you, how many additional operating hours you can add on every week? So one easy way to think about this is if you can extend your operating hours by one hour every day, that’s why I’m getting five hours here. So Monday, Tuesday, Wednesday, Thursday, Friday, if we just extend that time, that can also impact how you can accommodate that post-COVID surge. OK. So these are the values that get input into the model. I’m going to talk a little bit about the calculations on how we calculate that recovery time, the backlog, and the recovery speed. So the total time that you need to recover, so that’s the time of this green line, that tells me that it’s going to recover in mid-September. But that’s dependent on the overall size of a backlog divided by the recovery speed. And the size for backlog is calculated based off of new patients. So with the decline in patients being screened and diagnosed, there are going to be fewer new treatments. So that’s one piece of it. And the other piece is deferrals from existing patients. So some of these, equals your total backlog. And Then for your recovery speed, this is largely dependent on how much additional capacity you can see in the post recovery state. So this is where these levers to accommodate the post-COVID-19 surge come in. So there are many ways to do this. But the way it’s built into this model include just what happened to the extend operating hours. What happens if you pull in additional chairs? And then if you have your operations run as usual, can you pump up the total volumes that you’re seeing daily? So that additional volume that you see, that contributes to how quickly you can recover those patients. All right. So what’s actually playing around with the levers here. So I want you to see how these parameters can actually affect the shape of your group. So say, 50 appointments, say you’re also able to open up on Saturdays or some days, and you think that’ll be an additional 30 appointments a week. So I can go ahead and change this to 80 here. And you can see that that brought my estimate from mid-September to mid-August. And say, you’re able to borrow five more chairs from another department. If I change it from 40 to 45, not too much of a change. Try a slightly larger number. And then finally, for additional operating hours, so this is assuming that I can extend it by five hours a week, let’s say that you can push it by half an hour more, so how does that affect it? 1.5– OK. So each of these is a tiny change. But if you put it all together, it can end up impacting your overall timeline by quite a bit. So these are some of the factors that you can consider while planning out your recovery. So I’m going to jump back, and put into the slide. Like we said, if you are an iQueue customer, there are a lot more levers. I think Ashley showed the math slide. There is a lot that you can control. I’m going to talk about some more of those. So potential levers by category, so we really think about it in three different categories. There’s staffing. There’s scheduling. And then there’s your overall physical setup. So, what are some ways you can increase your capacity and increase your overall velocity of recovery through staffing? So, can you bring in more nurses? And also, these nurses that you have, is there a more effective way that better utilizes your staff? On the scheduling side, so we talked about the impact of extending operations on weekdays or weekends. But also, something to consider is, can you more effectively utilize your mornings or afternoons since everyone wants to come in that midday peak. And then in terms of the physical setup that we spoke about, are there additional chairs or beds that you could gain access to? But also, there is the potential to– if your current setup is in pods, or you have different areas. Pooling is always a great way to squeeze a little bit more efficiency out of what you have. So these are some of the ways that you can change your curve. And it does rely on a little bit of change in your overall scheduling system. So something to keep in mind is that without– if you don’t try to push for some of these changes, you might think that the most patient centric thing is to give patients the choice of when they want to come in. But what that will effectively do is everyone will want to come in the middle of the day, and then everyone will want to wait. And in this post-COVID time, or in the time of COVID-19 too, it is very important that you do try to minimize the patient’s overall exposure in the hospital. OK. So now, we have an interactive poll. And we want to know, which of the levers that we talked about are you most likely to pull to help you through your recovery? So are you able to increase operating hours on weekdays, weekends? Let me pull up this poll. OK. So which levers are you most likely to pull to help you through your recovery? So there’s increasing operating hours on the weekdays, increasing operating hours on the weekends. We talked about additional staffing, opening up additional chairs or beds, also pulling multiple resources. So, let’s see. We have 50 responses so far. Give you guys a couple more seconds to enter that in. And again, you can even choose all that apply here. About half of you have voted, right? And pull– And then I’m going to share the results. So what I’m happy to see is that it looks like everyone is considering something different. The most popular one is increasing your operating hours. Perhaps, many of you are already doing that because with social distancing. You’re unable to use as many of your chairs. So the only way to squeeze in more patients right now is to flatten that curve on a daily basis. So, again, the calculator that we showed you can tell you the timing of your recovery’s journey. But it’s really be levers– it’s really these levers that determine the actual path of recovery. So I’ll hand the ball back over to Ashley now. We’ll be talking more on how you can effectively execute against the solid post recovery plan.

ASHLEY JOSEPH: Thank you, Helen. So hopefully, you guys have a good sense of the way that the calculator works, and the sorts of levers that you can pull in order to achieve whatever the curve is that you decide that you want to achieve. What I want to talk about quickly before we move into Q&A– and by the way, please do continue to put questions in the Q&A box. We’ll try to answer as many as we can at the end. I want to talk a little bit about the change management that goes with the post-COVID surge that you’ll feel. Now, I know that all of you, we certainly know this from working with infusion centers around the country. All of you are very good with change management in a typical environment. We think though that there’s going to be some things that make this particularly challenging. Primarily, because everybody across your organization is doing change management simultaneously. You’re pulling multiple levers at the same time while everyone else is doing that as well, which could lead to some chaos and some crazy if things aren’t carefully planned. The first two things are to think about communication, and think about it probably more broadly than you ever have before. So certainly, when you make change, you’re going to typically think about nursing and pharmacy. But right now, there’s some other things that you probably are going to need to think about that may or may not come up in typical change management. There’s some regulatory requirements, certainly, that are up and down. A lot of times, we know that in some places, just changing operating hours requires communication to the Department of Health. And that’s something that if you haven’t changed operating hours in five years, then you may not even think about those sorts of things. But they are important. Think about things like if you change operating hours, what do you need to do about security? Make sure that you have interpreters available at the hours that you’re moving. And then things as simple as getting engineering to adjust [INAUDIBLE] at times the day when they would typically turn on or off heat, or air, or whatever that they may be in your particular environment. Just think much more broadly about things. Also, because everyone else is doing major changes simultaneously, think about who do you need to make sure includes you in their planning. So reaching out proactively to make sure that you’re on the list for those who are planning for other areas that also involve your infusion center. And then finally, I think that this is a really important point, that I think we all know intuitively. But it’s easy to forget when we’re in the thick of things. I think we all have to expect the transition back to normal or to business as usual to be more difficult for some staff, and for others. And especially in the light of furloughs and things like that, that we know are going on some places. Those of us that have been living in this completely during the COVID time itself, have one lens on getting back to normal. But everybody has lived several lifetimes during this shelter in place period. And it will have been extremely hard for some of your employees. And they may have dealt with loss, and other things during the time that they’ve been gone from the center. So just make sure to give grace, and remember that everybody’s back to normal. We’ll feel a little different way more so than a typical change management situation that you would normally manage. And then finally, we would say make sure that you don’t forget all of those best practices operations things. And we think that there’s some best practices operations things that probably fly a lot more in this COVID/post-COVID period. So obviously, you’re going to track your weekly volumes over time. You’re going to look for trends. And you’re going to make adjustments as necessary. That’s just motherhood and apple pie when it comes to making change, right? But make sure, especially in this period more so than in any, that you don’t allow any single data point to overly influence decision-making, or cause you to make decisions without letting things ride a bit. Expect that there will be hiccups. Remember, you’re kind of making things up on the fly. This isn’t the situation where you will have had months to plan as you typically would before you go into a big change management effort. So make sure that you don’t let one day of data or one day of operational issues cause you to overcorrect. You never want to do that. It’s short small movement as opposed to large ones. Make sure that you’re sharing data and friends with your team. I can’t emphasize this enough. Again, those of us who have been living in it every day, we understand why we’re making changes, why we’re making them so quickly. But if you’re just a nurse who is coming in without all of that context, it feels to them as though the rules change every day. And they just can’t keep up. The best way to counter that is to share the wise with them when you make a change, especially if you’re making rapid fire changes each day, or even multiple times within a day. The more you can share the whys, the better that you’re likely to do with getting folks to embrace change management. And then I would encourage you to remember that some of the ideas come from the most unlikely places. So some of you will have use floaters or travelers, or others, during the COVID period, that are new to your area. Ask them. What have they seen that is really good about your center? What have they seen that is really not so good about your center? Had they seen things in other places that would be helpful for what you do? So often, we forget that some of the best ideas come from the people that are able to see the forest for the trees. And that is sometimes the people that have been there for the least amount of time, and know the least about why things are as they are today. I really want to stress this next point. Look for positive changes that were made because of COVID-19 in your centers, and consider embracing them as permanent. I can’t tell you how many times we’ve heard over the last few weeks– well, for the time being, we’re doing x, y, and z. But we’re going to go back to doing a, b, or c. Consider all the things that these x, y, and z things that you’ve and, consider whether it’s actually a good idea to make them permanent. The COVID time has been characterized by things that make for really good problem solving, so scrappy, speedy decision-making, nimble empowered implementation, creative out-of-the-box problem solving. In this inclusive battlefield change management way of thinking, we had one center tell us that they had a plan in place to implement telemedicine over the next x number of years. And boom, within two minutes, or within two weeks, it had all been implemented. And so I’m sure that all of you were seeing that sort of thing, how much of this can you make permanent? It’s really important to think about– for example, we had central that said that now, they’re doing check-ins from the car via texts. And so now, when someone comes into the center, they literally go straight to their chairs. What would the world look like if suddenly, you didn’t have a waiting room in some of your centers? Think outside the box. How would this work if you thought about it in your moving forward period, and be willing to embrace change in a way that you may not have in the past? And then please make sure you’re taking time to record strategies that you’re creating on the fly. We’re trying to do this too as we hear great ideas. But sometimes we get so caught up in the moment of all the things that have to happen, and we don’t do it. Take the time to do it because we know that this may come in waves. And you’ll be ready for the next big event that happens. So we’ve said a lot, we’ve thrown a lot at you over the last 40 minutes or so. We want to make sure we’ve got some time here for questions. And I see that there is a queue of those building. Before we move to questions though, I do want to talk for just a minute about what comes next. So if you’re already an iQueue customer we’ve already been talking with you on your team about how to use these tools and we’re able to take your actual center specific data and help you fill in the recovery calculator based upon your actual data If you’re not a customer though, we would still encourage you to use the recovery model calculator. As much as you possibly can, play with the input, see what makes sense. And if you have issues, or you need help, or have additional questions, please do reach out to us. It is email. And even though you don’t have a dedicated project manager or product manager as [INAUDIBLE] customer [INAUDIBLE],, we will make sure that somebody who is knowledgeable and can be helpful to you does reach out to you as quickly as possible, and helps you work with the calculator, and helps you figure out how to get the data that you do need in order to make it work. If you’re having issues there. So with that, I want to come to a stopping point in terms of the presentation, and try to switch over to some of the questions that have come in. And I’m going to field some of these myself. And I’m going to send some of them over to Helen. And we also have a few other experts standing by in case we need to go there. The first question was about the initial decline. So we talked about that around March 16 was the date that we started to see. Decline the question was about spring break, and that was actually the spring break period for her center. And were we able to parse out COVID versus spring break? So a couple of things there. First of all, the spring break week is actually quite various across different parts of the country. So when you look at the rolled up statistics that we showed, it’s a pretty good guess that the drop that we saw starting on 3/16 was actually COVID, and not spring break. However, for an individual, center 8you would be able to parse out COVID versus spring break because you will be able to look back at your historicals, and have a sense of what happened in previous years during that same spring break week versus what happened this year, which would give you a sense of what was COVID and what was spring break. So, good question. Question about, is the week including weekends, or just weekdays? Helen, do you want to take that? HELEN LIU: Yeah, sure. So the week does include weekends. I was just talking about weekdays only to make my math simple. It’s a lot easier to multiply by five [INAUDIBLE] than it is to think about weekdays and weekends separately in the calculator. When it’s asking how many additional volumes you can add [INAUDIBLE] I would think about your weekdays and your weekends separately. So that’s how we got 50, which is from the 10 extra per weekday, plus the 20 that we said was just from opening on Saturdays or Sundays. ASHLEY JOSEPH: Great. The next question was to explain pooling resources. Do you want to take that one as well Helen?

HELEN LIU: Yeah, yeah. So a lot of places that we see that you might be subdividing your appointments by pods, sometimes even by chair or by nurse, and what we find is just when you do not pod, we look at everything kind of as one if it’s possible. We know some places you do have to separate COVID positive patients from non-COVID positive patients. But the more you can pull everything together, there is an increase in efficiency that you can get from thinking of all of your resources as one.

ASHLEY JOSEPH: Awesome. Thank you. We have a question about other tools. So whether we’ll have other tools to help with clinic volumes, and other volumes that aren’t infusion volume. So right now, we have two primary tools as LeanTaaS. One is the tool we shared with you today. The other is a tool that looks that ORs who will bring back those elective procedures that everyone is shut down, and how ORs can better manage that same transition, that same surge that they’re going to see as infusion centers will. So that calculator is also available. I don’t think that we have a clinic volume calculator in the works right now. But we do have some other tools that we are working on, so be on the lookout for other webinars in the future to talk about those.

HELEN LIU: [INAUDIBLE] to the clinic’s piece, so as you might have noticed, the clinic volumes are included in the infusion volumes. So there are ways that you can look at your clinic data based on the lead times, the types of appointments that are getting canceled. But overall decrease in new patients coming through that where you can help estimate what that overall decline in clinic volumes would look like. So we don’t have a tool for that, but the techniques are definitely there. We’re happy to help with that.

ASHLEY JOSEPH: So let me hand over to you, Helen, about the question we have here about recommendations for how to manage with lower volume before we have the surge in volume. So what are some of the best practices that you’re seeing organizations use right now?

HELEN LIU: Yeah. So I know that we had a webinar with Jamie Bachman from UCHealth a couple weeks ago that talked about this. But some of the key things that stood out are– one thing that many, many centers are doing is they’re building in new schedule systems, new templates for social distancing. So they’re saying instead of having 20 chairs available, we only have 10. How do we maximize the patients who can still come in without those 10 additional chairs? So like we said, some of that does involve extending hours a little bit, assuming that more patients are not going to be able to come in the middle of the day. They’re going to have to come earlier in the day and later in the. Day But social distancing templates, as we like to call it, that’s kind of been the main strategy that we see is used quite broadly. In addition to that, we have seen some centers carve out additional space just for COVID positive patients or COVID research patients, and then put that out together. And then some centers, they’ve gone through heavier physical movements. So they’ve had to close down one center, and completely move their volumes to a different center. But I would say the main strategy that you can probably employ, because if you’re moving, you’re properly forced into that, is really thinking how can I manage my schedule so that I don’t run into having 20 patients come in all the time when I can only have 10. ASHLEY JOSEPH: So we may also– I’m guessing that embedded in some of these things are questions about staffing management with different volumes. And we actually are working on a specific staffing tool to help you with that. So, again, be on the lookout for additional webinars that would We have a question about differences or different ideas for managing national holidays over this time. And that’s not one that I’ve personally thought much about. Helen, do you have any thoughts there, for managing national holidays? HELEN LIU: So holidays, what we find in a lot of centers is that the hours may change, the staffing may change. So really taking that into account when designing the schedule for those days. You may say I’m going to have fewer staff. I’m going to have everyone pool in this area of my infusion center instead. So it’s important to get those schedules entered into your EHR, well, before the fact, so that you can look into them, and not exceed the number of shares that you have opened that day, or the [INAUDIBLE] number of nurses that you have working that day. I’m sorry. I’m just realizing, Camillia, that this is also about for places that close on the holidays. So when you do close one day, that means you’re going to have a mini surge maybe the days before or the days after. So similar to the idea that we were talking about with the post-COVID-19 surge template. You will want to think about staffing up for the days around, and also maybe employ higher volume templates for those days.

ASHLEY JOSEPH: OK. So I’m looking at the other questions I think we’ve touched on most of the other questions that have come up. Does anybody have any additional questions for us? Really about any topic that could be helpful? We’ve got a couple more coming in. Out of the organizations we partner with, what percentage have scheduling practices that decoupled provider appointments from chemo visits? So we talked a little bit about the difference in this at the very beginning when we were talking about the difference in linked and unlinked appointments. Helen, do you want to talk about our general thinking on linked versus unlinked appointments? And how we think about it strategically?

HELEN LIU: Yeah. So the answer to your question is that many of institutions that we work with have been decoupling provider appointments from chemo visits. Not every visit is decoupled, but small proportion are prior to COVID-19 and then post-COVID-19, what we’re seeing is that with the move to help telehealth, the number of decoupled appointments, or unlink as we call it. That number has grown quite a lot. And in our opinion, having the appointments be unlinked is actually a very good strategy to open up more of your capacity earlier in the day or later in the day because you know that the timing of your infusion appointment will not be as dependent on the timing of that provider visit. So in this post-COVID time, when the number one priority is to see as many patients as you can while making sure that the patients are not sitting around in the waiting room, especially because they may be immunocompromised or more at risk. So it is important to have the patients come in at a time, get their treatment right away, and not have to wait around in between visits. So overall, yes, we should take advantage of this overall move to more telehealth to take advantage of a decoupling of appointments so that by midday peak that we see, in the day peak where everyone wants to come in the middle of day because that’s right after the provider appointment. That midday peak is crush a bit.

ASHLEY JOSEPH: Thanks, Helen. OK. So does anybody else have questions 1before we send you back to– do all of the things in your infusion centers. All right. Well, thank you so much for joining us. It’s been a pleasure to be here. Thank you for the questions. Thank you for the participation in the polls. We really do hope that you find the recovery tool to be helpful. And we do look forward to continuing to work with those of you who are current customers to get the recovery model tweaked exactly to meet your specific parameters. And for those of you that are just being introduced to LeanTaas today, we hope that you will reach out if we can help you in any way during this time. 1That’s certainly what we aspire to do, as we all try to be relevant and want to help health care as best we can, especially those of you that are on the front lines. Thank you so much. And we’ll hope to see you all again in a future webinar.

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