Primary Care at Risk Amid COVID-19 Pandemic
In 2016, primary care physicians provided 54.5% of all patient care visits and are the same physicians who manage the most of the care for people with high-risk conditions that make them vulnerable for contracting coronavirus. However, most primary care practices are seeing a 30–70% reduction in patient visits due to the COVID-19 pandemic.
In a poignant and eye-opening piece, authors compare the pandemic’s financial impact on primary care to the early phase of a tsunami, “the devastating effects of a tsunami are usually preceded by an abnormally fast and long low tide, as water is actually pulled away from shore toward the epicenter of the underwater earthquake. Most of the US currently sits in that temporary equipoise.”
Primary care physicians are depended upon for most health care needs, especially in small towns and rural areas. Frontline primary care practices are largely dependent on fee-for-service payments which drop as care volume drops and it is estimated that a 50% reduction in visits will cost the most vulnerable of these $700 million over the next 3 months, more if they are unable to rapidly stand up telemedicine. They face tough decisions about laying off staff or even closing their practices right before COVID-19 hits their communities. These vulnerable family medicine practices are only a small subset of practices facing these difficult decisions. Primary care physicians are likely to be called up to serve their local hospitals, particularly in rural and underserved areas, adding to their financial detriment.
While the most recent stimulus package related to the pandemic allocated $100 billion for health care providers, most is likely to go to hospitals, and, nothing was specifically allocated for the majority of frontline clinicians. The periodic interim payments authorized for practices caring for Medicare beneficiaries are starting to flow, but while these solve a short-term cash flow, Medicare makes up only a minority of most primary care patients. The second problem with this policy is that the payments are loans that must be paid back within a year or later with steep interest. It is hard to imagine that these practices can increase volume sufficiently after the pandemic passes to pay back these loans.
In the midst of this pandemic that continues to evolve, government should support frontline primary care physicians as they fulfill their unwavering commitment to the social contract, caring for their patients and communities every day.
The full article, The COVID-19 Tsunami: The Tide Goes Out Before It Comes In, can be found by clicking here.