What is happening with primary care?

May 19, 2020

Leona Rajaee

Primary care practices are small businesses and, as such, are challenged with remaining financially viable during COVID-19. Primary care physicians and their staff are also struggling with their main goal of providing appropriate and quality healthcare to their patients. Many have shifted to telehealth services but are finding that patients may not have the resources to access the proper technology. Several recent surveys and research studies show what is happening with primary care during the coronavirus outbreak.

In attempt to keep everyone safe and healthy, primary care practices are actively discouraging patients from visiting their office for routine care. In fact, fewer than 20% of the usual visits are now held in person. Insurers are paying for telemedicine visits in an effort to accommodate the situation, but Medicare is currently reimbursing virtual visits at approximately half the fee of in-person visits.

A weekly survey conducted jointly by the Larry Green Center and the Primary Care Collaborative sheds light on what is happening with primary care during COVID-19. The survey conducted of 1,000 primary care clinicians during the week of April 3-6, 2020, revealed that:

Patient mental health is being recognized as a critical need. 54% report that COVID-19 has led to increased numbers of patients with mental or emotional health needs. The vast majority of surveyed clinicians report that evaluating patients’ psychological/emotional concerns as either a high (30%) or moderate (50%) priority for patient care.
Despite increasing billing flexibilities, primary care is facing payment challenges. Only 54% of respondents say that the majority (>50%) of their office contacts last week were reimbursable.
90% of those surveyed report limited well and chronic visits as a stress on their practice; 58% report that they have too few sick visits available for patients. Only 7% report “scheduling preventive visits” as a high priority in the past week.
Adequate personal protective equipment remains a critical obstacle for primary care staff. 58% report the use of used and homemade PPE at their practice.
The pandemic continues to place high levels of strain on primary care practices. Just under half (49%) of respondents report that the current status of COVID-19 is having a “severe” impact on their practice. This is up from 44% the week before.

In the follow-up survey, conducted April 10-13, 2020, findings regarding frontline primary care clinicians’ experience with COVID-19 included:

Specific Main Findings

34% of clinicians report no capacity for COVID-19 testing and 32% have only limited capacity
Outages due to illness/quarantine reported for clinicians (36%), nursing staff (35%), and front desk (31%)
41% of clinicians rate the COVID-related stress on their practice as severe; 34% rate it close to severe
53% lack PPE; 58% rely on used and homemade PPE
12% of clinicians see disparities among racial minorities; 27% among low income patients; 20% among those lacking computer/internet access; 29% among those with mental health conditions; 33% among the elderly

Virtual Health Findings

65% of clinicians report they have patients who can’t use virtual health (no computer/internet)
Full scale use of virtual platforms is limited: 34% rely on majority use of video, 15% on e-visits, and 19% on patient portal, compared with 48% conducting the majority of visits by phone
22% of practices report no use of video visits, 42% no use of e-visits, and 28% are not using patient portals

Survey respondents also indicated that financial vulnerabilities are high. Over the next 4 weeks:

3% predict closure due to low staffing; 14% unsure if they will have enough staff to stay open
12% predict closure due to low patient volume; 43% unsure if they will have enough patient volume
6% predict closure due to lack of cash on hand; 47% unsure if they will have enough cash to stay open
10% have not received payment for video/e-based care; 16% have not received payment for phone-based care

Primary care physicians writing in a recent issue of StatNews emphasized that “The Covid-19 crisis is revealing the financial peril of relying on billable, in-person visits as the main way to pay for primary care, which provides little backstop in times of crisis.” They encourage heeding “the lesson of the Covid-19 crisis to protect primary care in a foundational way that will matter even more once the pandemic is over.”