Eyeworld Supplements

4 | SUPPLEMENT TO EYEWORLD | AUGUST 2020 Turning the Lights Back On via telehealth, at Bascom Palmer Eye Institute we are performing a whole array of telehealth services for new, follow-up, and post- op patients. These include urgent care/triage visits, doc- tor-to-doctor consults, virtual counseling, second-opinion consults, hybrid televisits, drive-thru IOP checks, res- ident/ER tele-staffing, and remote slit lamp exams. One of my most success- ful telehealth visits has been discussions about cataract sur- gery and advanced technology IOLs. We use this tele-coun- seling time to talk about the kind of outcome patients are expecting and how they want to see. They're at home and in front of their computers, and the really precise patients will tell me, "I'm 16 inches from my computer screen now," as they come to understand what their "intermediate" vision would be with an advanced technology IOL. You really get to see them and the way they work in their home environ- ments. They seem more re- laxed in these visits; I'm more relaxed in these visits. Often- times, their family is there in person or we invite them to join the video call; they participate, too. It becomes a completely different conversa- tion, and I can't tell you how successful this has been. I think if you're going to do cataract surgery, you should try to give patients the best visual outcome you can. It's about giving patients the freedom to see the price tag when they're shopping in the grocery store then being able to drive home, about seeing the menu in a restaurant with- out having to bring out the phone's flashlight but still rec- ognizing a friend waving from across the room. That's all so important to our patients. T o say that medical practices have had to adjust to survive as a business through the pandemic is an understatement. In the Turning the Lights Back On: Part 2 session, Bruce Maller discussed what practices should be doing now not just to survive but to "hopefully get to the point where we can be paid a fair wage … while also seeing some return on the risk many of you assume as business owners." "There are a few things I want to emphasize that will give you that feeling of control," Mr. Maller said. These include understanding the value of forecasting, employing greater rigor in decision making, and learning how to more effectively align economic incentives. When thinking about how to manage a business through a crisis, Mr. Maller broke it into three phases. Phase 1: This is a time of survival, when the depth and breadth of the situation are unknown, Mr. Maller said. It's a time to engage staff, monitor daily/weekly cash flow, shore up your balance sheet, and size your cost structure appropri- ately. Phase 2: This phase is when you wake to a new reality with a new mindset. At this point, Mr. Maller said it's im- portant to determine what your new normal is in terms of breakeven. Create a 2020 forecast, refine your cost structure to align with your new reality, and find your footing, Mr. Maller said. Phase 3: Shine a light on the future and begin to think ahead. Mr. Maller said it's important to create a model for each line of business, look at historical results, calculate monthly averages, build your revenue forecast, review each line item or expense (forget historical norms and start at zero; iden- tify things that are essential and non-essential), align cost structure to the new reality in terms of revenue, find your breakeven point, and model "what if" scenarios. The federal government also made changes to help busi- nesses through this challenging time. Jeffrey Kimbell gave an update on these efforts from Washington, D.C., including several tax provisions within the CARES Act to help busi- nesses remain viable and retain employees. Tax credits for idle workers: Businesses impacted by the pandemic can receive a tax credit for keeping idle workers on their payroll equal to half of what they spend on wages (up to $5,000 per worker). This tax credit, Mr. Kim- bell explained, applies to businesses whose operations were fully or partially suspended due to a government order, a COVID-19 outbreak, or a significant decline in gross receipts. Mr. Kimbell also noted that employers cannot take part in this tax credit in combination with SBA/Treasury-backed loans. Deferral of payroll taxes: The 6.2% employer payroll taxes can be deferred until the end of the year. Deferred employment taxes must be paid back over the following 2 years, with half of the amount due by Dec. 31, 2021, and the other half due by Dec. 31, 2022. Net operating losses and other credits: Net operating losses arising in tax years beginning in 2018, 2019, or 2020 can be carried back to 5 years, Mr. Kimbell presented. The taxable income limitation has been temporarily removed to allow net operating losses to fully offset income. Editors' note: Mr. Kimbell is the president and CEO of Jeffrey J. Kimbell & Associates and is based in Washington, D.C. Mr. Maller is the founder and CEO of BSM Consulting and is based in Incline Village, Nevada. Business planning and tax policy changes continued from page 3 continued on page 5

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