Primary care is essential
A pandemic-related reduction in the number of primary care physicians would exacerbate what many observers view as a nationwide shortage of primary care. Right now, the health care system badly needs all the primary care doctors it has, Ms. Abrams and Dr. Mostashari said.
Decades of research have shown that strong primary care is associated with better outcomes, lower per capita costs, and greater equity, Ms. Abrams noted. In addition, she said, dedicated support for primary care during the pandemic will help ensure that doctors meet the needs of patients with chronic diseases so they don’t have to be hospitalized.
Moreover, with proper support, primary care physicians can expand COVID-19 testing “so we can reopen the economy and perhaps prevent or contain the second wave of the virus,” she said.
Dr. Mostashari pointed out that primary care providers are on the front line of the pandemic. Although much attention has been rightfully given to those who treat COVID-19 patients in hospitals, he observed, “before those patients are admitted, they need to see primary care physicians. ... We have to maintain the primary care first line of defense. When the CDC says if you’re having symptoms, call your doctor, someone has to pick up the phone at the other end.”
In addition, he said, “there’s a hidden pandemic of untreated chronic conditions we should all be worried about. We know primary care is important because if you don’t do prevention, you’ll pay the price in heart attacks and strokes and kidney failure, and we’ve seen a dramatic decline in primary care services. In New York City, some people who have avoided necessary care have had bad outcomes, including in-home cardiac death.”
Dr. Mostashari also argued that the negative financial impact of COVID-19 could lead to a further consolidation of the industry as health systems and private equity investors take over failing practices. Past experience suggests that that would result in “a lack of choice, a lack of competition, and a lack of access” in many cases, he said.
The best long-term solution, he said, is to pay primary care physicians capitation instead of on a fee-for-service basis so that they’re not dependent on income from face-to-face visits.
In the short term, however, they need direct cash payments, Dr. Mostashari said. He called on Congress to allocate at least $15 billion to bolster the viability of primary care practices.
Telehealth levels off
One of the key findings of the outpatient visits study is that telehealth encounters, after soaring in the early days of the pandemic, have leveled off. After hitting a peak of 14% of all visits in mid-April, telehealth visits now make up about 12% of the total.
Study coauthor Ateev Mehrotra, MD, MPH, an associate professor of health policy and medicine at Harvard Medical School, Boston, said he’d expected the use of telehealth to continue rising. The fact that it hasn’t, he told reporters at the news conference, may be related to the different ways in which practices conduct virtual encounters.
“Some practices are using HIPAA-compliant [telehealth] platforms and training their patients on how to use those platforms,” Dr. Mehrotra noted. “Other clinics are mainly just phoning patients. You could envision those practices could easily revert back to in-person visits, because a phone call is going to be limited in many cases. Also, practices need to know whether payers will keep covering telehealth after the pandemic is over.”
The study shows that in-person visits, which declined more than total visits in March and early April, are now increasing at about the same rate as total visits. However, in-person visits are still down by more than 40%.
Asked whether financially vulnerable practices will be able to afford the safeguards that medical societies recommend to resume in-person visits, Dr. Mostashari pointed out that Medicare is now paying $28 to collect a COVID-19 specimen from a patient.
“Just the cost of changing PPE, plus disinfecting the room or setting up a separate room or testing facility: Those expenses are not included. We should have better accounting on what it actually costs to run a practice in the time of COVID. It’s not the same as their earlier operating costs.”
Dr. Mehrotra agreed. “You also can’t have 20 people in your waiting room or the throughput you had previously. So the number of patients you’ll be able to see will be lower because of appropriate restrictions.”
A version of this article originally appeared on Medscape.com.