Dr. Shivesh Kumar is a Family Medicine Specialist with over ten years of experience. He is a member of the American Board of Family Medicine, focusing on partnering with large insurance companies and hospital systems. Standing in the middle of the two prominent health...
A Tale of Two Crises: The Pandemics of COVID-19 and Struggling Primary Care
Small businesses across America are struggling. Amid lockdowns and COVID-19 fears, it’s easy for people to forget that many of those small businesses are primary care practices. The irony is not lost on the doctors, nurses and office workers who strive to keep America healthy. While they weigh risks to their own health in order to keep us well, the orders designed to prevent the spread of the coronavirus may in fact hinder the livelihood for the very people who are there in our defense. The economic impact of the systems that are designed to protect us may well have a lasting effect on those valiant heroes of the health care system.
Small practices face the concern of having to close their doors
As a protection against COVID-19, primary care and specialists alike are asking patients to postpone routine care indefinitely, and while there’s a rise in telehealth as a supplement, regular doctor visits are at less than 20% of their regular numbers. The CDC, the Centers for Medicare & Medicaid Services (CMS), and the American Medical Association have all created guides for small health care practices to utilize in an effort to keep their doors open, while protecting the health of patients and staff. This includes input for following government compliance, handling infected staff, transitioning to telehealth, tele-triage, scripts for staff to follow, coordinating with local hospitals, limiting patient visitors, handling legal issues and more. While small practices try to comply with the same processes as large facilities, many are unable to sustain reduced costs, having to resort to closing their doors permanently.
More than 30% of primary care physicians worry that they don’t have the funds to keep their practices open beyond a single month of continued lockdowns, leaving as many as 60,000 primary care practices in the U.S. that will likely close or experience dramatic staff cuts. These are staggering numbers that can affect us all. That actual figures mean that more than “8 percent of the doctors reported closing their offices…” which is believed to be in excess of 16,000 practices. This is expected to exceed another 4 percent in coming months.
Many doctors and nurses are choosing early retirement over the risks to their own health, thinking of their future with their families over family practice. 59% of physicians anticipate COVID-19 to reduce the number of independent physician practices in their communities. While these numbers are devastating system-wide, losses in income are likely to be worse for specialists than primary care. 43 percent of physicians have reduced their staff, while over 100,000 “have switched to a primarily telemedicine practice”.For those practices that don’t close, there is a high expectation of laying off more staff amid the uncertainty.
We’re here from the government, and we’re here to help
Some believe that the fragility of primary care is that “most of these practices, and much of our health care system, rely on an outdated payment model: Each in-person visit with a patient generates a payment. Without in-person visits, there is little to no revenue.”
These fears for the small, independent health care business lead many to suggest a global budget where “primary care practices would be paid a monthly fixed fee to care for their patients…” with bundled payments for everything from “surgical and cancer care to population-based global budgets for health care delivery systems.”
The Paycheck Protection Program has helped rescue most practices for now, but the call for large, sweeping shifts in the economic structure of the health system seems to be the only remedy people believe will rescue small practices from becoming a thing of the past.
Large hospital facilities are the winners
The coronavirus has changed health care on all levels, and in all areas, but large hospitals have a direct connection to government, and that comes with economic and systemic benefits, training, and protocols that all but guarantee they will be absorbing a large percent of future business from closing small practices. These independent family care and specialist practices have to fight for protective supplies like gloves and masks that are more readily available to large hospitals. While they are to follow the same procedures to protect the public health, they are treated the same as any small business when it comes to fending for themselves. It seems that even with technologies that are readily available for all, the large facilities are going to see an increase in governmental connectivity and protections to keep their systems entact, and thus keeping their employees on the payroll.
Telehealth is the future of small practice
For those independent practices that intend to fight to remain open until the bitter end, telehealth is the gateway from now into the future. It almost seems like an intentional push towards the future of medicine, but it took a global pandemic to make it obvious that it is time to lean heavier on technology. Telehealth is paid to small practices similar to in-person visits, and while Medicare covers telemedicine sessions, doctors are paid roughly half what they earn for meeting with patients in person. With families staying home, telehealth is a solution, but one with many side effects of its own. More than 70 percent of physicians don’t believe that telehealth can continue without a rise in reimbursement.
The truth is, that physicians are facing some hard times ahead. Telehealth is a clear direction they will all need to consider, but there are no guarantees that they will be paid what is needed from this alone. It may be a combination of government intervention, future technologies and the success of vaccines that help the small practices to survive, but there is a strong possibility that the shift will be more severe, and more permanent. For some, the inevitable may be that in order to remain in practice, they will have to join larger facilities to reduce uncertainty.
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