Reading the latest coronavirus news and watching daily briefings, it’s easy to miss the devastating economic burden COVID-19 is putting on independent primary care physicians. “Our practice is losing tons of money and we don't know how long we can last,“ said one.
Reduced outpatient visits are only partially offset by telehealth calls and temporary increases in Medicare reimbursements. The revenue gap has increased the risk of permanent closure for these small businesses.
Based on a national, weekly survey fielded by the Primary Care Collaborative, almost half have laid off or furloughed employees since the crisis began, and many say they may not have enough cash to stay open if patient volume doesn’t increase in the next few months.
Independent primary care practices -- there are over 3,000 in New York City -- lack the resources and infrastructure of those owned by larger health care systems. The Collaborative is partnering with an NYC practice network to create new support services such as webinars on how to obtain loans, transition to telehealth, and optimize reimbursement.
These practices serve a largely immigrant, low income, and racially- and ethnically-diverse population, so keeping them open not only protects providers’ livelihoods but also maintains access to primary care for vulnerable populations.
Our May 13th survey found that only 16 percent are able to maintain their practice as usual. The most common source of stress is a loss of revenue followed by a persistent lack of PPE, a lack of testing, the need to lay off staff, and staff illness.
Providers also noted that telehealth is not the panacea we would like it to be. Many services are not possible or appropriate for telehealth, and patients experience obstacles such as lack of internet access, language barriers and general discomfort with the technology.
As we move to re-open and recover, primary care providers can offer testing and virtual monitoring to prevent hospitalization and ER visits, and provide a platform for expanding surveillance. But we need to provide them with resources to bring back reluctant patients and staff, including additional PPE and testing, higher reimbursement rates, and funding to transition to state-of-the-art telehealth programs.
As the federal government sends billions to bail out hospitals, primary care practices must compete with other small businesses to obtain loans and grants. Maybe COVID-19 will finally turn our attention to the foundations of the U.S. healthcare system, and view this crisis as an opportunity to focus resources on innovations that strengthen primary care.
Donna Shelley, MD, MPH
Professor of Public Health Policy and Management
Director of Global Center for Implementation Science