- One-fifth of primary care practices say they could close within the next month as the coronavirus pandemic continues to slam providers financially, according to a new survey of clinicians.
- Close to half of physicians aren't sure they have enough cash to keep their practices open, the Larry A. Green Center and Primary Care Collaborative survey of more than 2,600 doctors found. More than two-fifths have had to lay off or furlough staff to keep afloat as the large majority (85%) face dramatic decreases in patient volume.
- Financial support is increasing but often delayed, doctors say. Despite the healthcare system's flagging finances, the Trump administration is considering reopening the economy against the cautionary advice of public health experts.
The Trump administration began sending out financial lifelines to hospitals and other medical providers earlier this month in the form of expedited Medicare payments and funding from the $2.2 trillion Coronavirus Aid, Relief, and Economic Security stimulus package passed by Congress in March.
CARES benchmarked roughly $350 billion in emergency U.S. Small Business Administration loans, including providers with 500 employees or fewer. Roughly $39.89 billion in loans — 11.6% of the overall pot — went to the healthcare and social assistance industries. But the Paycheck Protection Program ran out on Thursday, and doctors and other small businesses report the application process is slow and difficult to navigate, further aggravating cash flow concerns.
A fourth rescue package is in the works for passage not likely until May at the earliest, and healthcare lobbies are already clamoring for a larger slice of the pie. PCC recommends Congress invest in a per-patient Medicaid and Medicare monthly payment to primary care practices for the remainder of 2020 and get additional support to the most vulnerable providers, including rural and safety-net practices.
"Help! We need help! I work all hours and I'm making nothing," one Virginia clinician wrote in response to the survey. "I used one of my precious few tests of [sic] myself. I have COVID-19. I no longer see patients in person but I still do telehealth or they have no one."
Most providers have turned to telehealth in a bid to recoup patient volume, but reimbursement for virtual care is often lower than an in-office visit — if it's reimbursed at all. A majority are unsure whether they'll be reimbursed for telehealth services, and full-scale use of virtual care is slight — 34% of practices rely mostly on video to conduct appointments, 15% on e-visits and 19% on a patient portal, compared to 48% of doctors conducting the majority of visits by phone, PCC found.
The Trump administration has dramatically expanded telehealth reimbursement, including temporarily allowing traditional Medicare to reimburse telehealth visits at the same rate as in-office visits. CMS also is letting doctors collect reimbursement for consultations conducted only over the phone, when previously video was required for payment. Many major commercial payers have followed suit, waiving co-pays for telehealth services.
But digital healthcare access remains flimsy, with 65% of clinicians in the PCC survey reporting they have patients who can't use telehealth because they don't have a computer or internet access. Congress allocated $200 million in CARES funding to the Federal Communications Commission to support providers' telehealth infrastructure. FCC rolled out the first wave of grants on Friday.
CMS on Sunday released guidelines for hospitals to restart elective surgeries put on hold to free up resources for coronavirus patients. The loss of elective treatments has been a large problem for providers financially as such procedures, like joint replacement, are a major source of revenue. Hospitals will have to meet certain criteria before reopening non-emergency, non-coronavirus care, including adequate staff, testing and supplies, and a lessening of COVID-19 cases in their state and region.
"Every patient is going to be different and every situation is going to be different, and that's why these are guidelines and recommendations," CMS Administrator Seema Verma said Monday on a call with reporters.
The American Hospital Association applauded the move, noting non-COVID-19 medical needs haven't gone away despite the pandemic. But the nationwide conversation about reopening the economy and loosening physical distancing requirements is complicated by a lack of reliable symptomatic and serotological testing, patchwork COVID-19 coordination among disparate levels of government and shortages of needed resources like personal protective equipment and ventilators.
The PCC survey found 34% of doctors don't have any capacity for COVID-19 testing and 32% have limited capacity. When it comes to PPE, 53% lack it altogether and 58% are relying on used and homemade PPE, threatening their safety as they treat patients with the contagious virus.