COVID-19 may cause many primary care practices to close, creating ‘crisis on steroids’
Many primary care practices have needed to lay off or furlough staff and potentially face closure in the next 4 weeks, according to results of a survey conducted by the Primary Care Collaborative and the Larry A. Green Center.
“Closure of primary care practices would be a crisis on steroids,” Ann Greiner, president and CEO of the Primary Care Collaborative, told Healio Primary Care.
She explained that primary care in the United States is already underinvested compared with health care systems in other industrialized nations, and is “skewed to acute and specialty care as opposed to health promotion, prevention and chronic care management — and that’s detrimental for patient outcomes and for costs.”
“If we have less primary care, unfortunately I think our system could be even more costly and have even poorer health outcomes,” she continued
Over 2,600 primary care physicians, physician assistants and nurse practitioners from all 50 states responded to the current survey, conducted from April 10 through April 13, 2020, according to a press release.
COVID-19 experiences in practice
The survey results showed that 34% of clinicians had no COVID-19 testing capacity, and 32% reported having limited testing capacity.
In addition, 53% reported that they lacked personal protective equipment (PPE), and 58% reported that their practices currently rely on used and homemade PPE.
Despite efforts to expand access to telehealth in practices — including CMS expanding telehealth coverage and providing payment for many additional services — 65% of clinicians reported that they had patients who could not use virtual health services.
Disparities in COVID-19 burden
The survey also provided further evidence that COVID-19 disproportionately impacts certain groups. Among respondents, 12% reported observing COVID-19-related disparities in racial minorities, 27% in low-income patients, 29% in patients with mental health conditions and 33% in the elderly.
“We need this information because by knowing how it is adversely effecting particular populations, then we can design interventions that will help to address those particular populations and their needs,” Greiner explained.
Financial distress in primary care
Among respondents, 85% reported a dramatic decrease in patient volume, and 42% were concerned about their practice furloughing or laying off staff.
According to a press release from the Larry A. Green Center, 20% of practices predict closing within 4 weeks.
The survey also found that 3% reported that their practice would close because of a low number of staff, and 14% said they were unsure if they had an adequate staff to remain open.
In addition, 12% of respondents predicted that their practice would close in the next 4 weeks because of low patient volume, and 43% were unsure if they would continue to see enough patients to remain open.
Many respondents also reported that they are not receiving payments for all visits, despite CMS announcing that it was expanding its coverage of telehealth services — 10% reported that they did not receive payment for video or e-visit care, and 16% reported that they did not receive payments for care they provided over the phone.
How to protect primary care
To help address the needs of primary care, Greiner said that stimulus packages should include more aid to practices.
Although emergency funds have already made their way through Congress, more support is needed for primary care practices, she stressed.
Greiner noted that although hospitals also need additional support, it is essential for primary care practices to receive more funds to remain open so they can triage patients — both those with COVID-19 and those with other conditions — and keep them from needing to present to the ED.
“We need to tap those emergency relief funds now so practices can stay open,” Greiner said.
To further address this need, the Primary Care Collaborative and the Larry A. Green Center made policy recommendations for the fourth stimulus bill to take action to ensure that primary care practices remain open, according to a press release. These actions include a policy for Medicare and Medicaid to provide per patient monthly payments to physicians, and for the stimulus to prioritize practices in rural and underserved communities. – by Erin Michael
Additional background: Sweeping regulatory changes to help U.S. healthcare system address COVID-19 patient surge. https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient. Accessed April 20, 2020.
Primary Care & COVID-19: Week 5 Survey. Primary Care Collaborative. https://www.pcpcc.org/2020/04/16/primary-care-covid-19-week-5-survey. Accessed April 20, 2020.
Disclosure: Greiner reports no relevant financial disclosures.