- The financial crisis facing primary care has mitigated somewhat, but doctors still need a lot of help, according to a new survey from the Larry A. Green Center and the Primary Care Collaborative.
- The survey, conducted Sept. 4 through Sept. 8, found 35% of primary care physicians say revenue and income are still significantly lower than they were before the COVID-19 pandemic, and losses are threatening insolvency both now and in the future. Another third of respondents say their financial situation has slowly been recovering, but overall the workforce is fragile and in trouble. About a fifth of practices have clinicians who have retired early or left their jobs as a direct result of COVID-19.
- The primary care groups called for more aid from Washington as a result. Another round of direct COVID-19 relief is highly unlikely as gridlock intensifies before the November presidential election. But a bill passed by the House on Tuesday to keep the federal government open does include some provisions that could help providers' bottom lines.
Primary care doctors have faced a more dire financial situation than most providers, as the majority of their revenue comes from in-person visits that fell precipitously starting in March. The situation has ameliorated somewhat as states lifted business restrictions, but it could get worse before it gets better. Public health experts and epidemiologists are warning of a potential resurgence of COVID-19 in the upcoming flu season, further stressing the nation's providers.
Primary care physicians are often a patient's first call when they worry they're sick. But an overwhelming majority of doctors in the field — 81% — don't think the primary care system has rebounded back to pre-COVID health, noting staff have yet to reach normal volume as significant layoffs and sick workers have shrunk the size of the workforce.
A third of doctors say their practice has empty job posts they can't fill, according to the survey of almost 500 primary care doctors in 49 states and Washington, D.C.
And the flu season just around the corner complicates the situation, especially efforts to procure needed equipment. About a third of practices are having difficulty getting enough COVID-19 testing supplies, like swabs and reagents, to meet patient demand. Another quarter can't get enough personal protective equipment.
Telehealth volume continues to keep many practices afloat, replacing lost in-person visits. Yet about 10% of doctors say their practices' telehealth use is less than a helpful amount, and don't have the funding to increase it. Virtual care platforms can be really expensive to implement — some tens of thousands of dollars depending on the vendor, the practice size and other factors — which is a nonstarter for some practices. There are also concerns about patient uptake, quality of virtual care and the continuity of reimbursement.
It seems payers are continuing to cover telehealth, despite fears reimbursement might be pared back as the pandemic drags on: 80% of respondents said their payer has continued coverage, while 18% said they had pulled it back. That 18%, while low, is still concerning as many doctors describe telehealth as a lifeline during COVID-19.
The pandemic also continues to exacerbate physician burnout, with almost half of doctors reporting their mental exhaustion at work is at an all-time high.
But federal and state pandemic support has either run out or is scheduled to run out soon, over a quarter of practices say. That raises the pressure on cash-strapped facilities, but not highly enough that they anticipate near-term closure. Only 3% say they'll likely close before December without more aid.
Yet Congress has largely punted on another COVID-19 relief bill, with gridlock in Washington mostly boiling down to the size of said relief. Republicans back a much skinnier package than Democrats, though sticking points also include legal protections for businesses, support for the uninsured and dollars for testing and contract tracing.
However, the continuing resolution passed by the House on Tuesday includes some measures that could help physician practices. If greenlit by the Senate, the bill would delay the repayment date for $100 billion in advanced Medicare loans to providers by a year. CMS was originally supposed to start recouping the loans late July, but hasn't done so yet.
The bill would also lower the recoupment rate to 25% for the first 11 months of repayment, down from its current 100% rate, and 50% for the next six months. Providers would have 29 months to pay back the funds in full before interest begins, and the interest rate would be lowered from 9.6% to 4%.