Primary care practices are facing an existential threat, and they need government help now if they are to survive.
That was the main message at a teleconference held on May 20 to announce the results of a study showing that outpatient visits have rebounded across the United States. Having dropped 60% from their prepandemic level in early April, office visits are now significantly higher but are still 30% less than the baseline, on average, according to new data from the Commonwealth Fund, Harvard University, and Phreesia, a health information technology firm.
The outpatient visits study shows that most of the recovery was attributable to a rise in in-person visits, not telehealth encounters, which have plateaued. The rebound was more pronounced in some regions, like the South and Southwest, than in others, such as New England and the Mid-Atlantic.
the study shows. While some other specialties have seen a greater drop-off in visits, speakers at the news conference drew reporters’ attention to the financial plight of primary care.
“Primary care practices are in dire straits, and their ability to treat patients is under threat,” said Melinda Abrams, MS, senior vice president of delivery system reform and international innovations for the Commonwealth Fund. “In the long term, an investment in primary care will ensure we have primary care, because we are concerned about its collapse.”
Health policy experts from the Commonwealth Fund and other organizations, she said, propose that the next round of federal economic stimulus funding include recovery resources dedicated to primary care practices, especially small practices and those in underserved areas. She said the money should be distributed immediately through Medicare and Medicaid in supplemental monthly payments.
Up to now, Ms. Abrams said, no money in any of the federal rescue packages has been specifically earmarked for primary care.
Close permanently?
Farzad Mostashari, MD, CEO of Aledade and former national coordinator for health information technology at the U.S. Department of Health & Human Services, agreed primary care needs immediate help.
Aledade’s customers for population health management services, he noted, are some of the most forward-looking and technologically savvy primary care groups. “Nevertheless, those practices are suffering,” Dr. Mostashari said. “Many of them are at risk financially. There has been a massive 60%-70% drop in face-to-face visits. About 40% of visits are telehealth, but the practices are still down 30% or more in visits. And they’re losing ancillary revenues from procedures and labs.”
The financial devastation of the pandemic is causing some physicians to question whether they will be able to stay in practice. A recent survey from the California Healthcare Foundation found that a third of California primary care doctors are worried their practices will be forced to close permanently because of the financial impact of COVID-19. Many doctors said their practices had furloughed or laid off staff or that they’d been forced to take pay cuts.
Similarly, a recent survey by the Patient-Centered Primary Care Collaborative found that 13% of practices predicted closure within the next month and that 20% have already had temporary closures. Forty-two percent of the practices have laid off or furloughed staff, and 51% are uncertain about their financial future through June.