Primary care physicians have been pushed to the breaking point in their response to the COVID-19 pandemic. A new survey conducted May 8-11 by the Larry A. Green Center and the Primary Care Collaborative shows that 84% of clinicians report having severe or close to severe stress, and 28% say burnout is at an all-time high.
Financial worries factor heavily into this stress, with payment differences across payers exacting a heavy toll: More than 50% of clinicians say they have received no payments in the last four weeks for virtual healthcare, while 18% report billing denied. And among those who have been paid, more than 60% say their telehealth visits are not reimbursed at the same level as face-to-face encounters, despite waivers granted by the Centers for Medicare and Medicaid Services.
"The primary care area is very difficult right now," said Dr. Rebecca Etz, codirector of the Larry A. Green Center and associate professor of family medicine and population health at Virginia Commonwealth University. "There have been dramatic reductions of face-to-face visits, which is the source of most billable income, and 50% of PCPs have no testing ability. Fifty percent have no PPE."
PRIMARY CARE AT RISK
Perhaps at no other time in history have primary care practices faced such risk and uncertainty. As many as 13% predict closure within the next month, and 20% have already had temporary closures. Nearly half have laid off or furloughed staff, and 51% are uncertain about their financial future one month out.
"It's like a mountain climber who jumps off with a leap of faith that their safety ropes are going to hold them, and you can watch the safety rope slowly fraying," said Etz. "What they really need is a hand. We need to figure out a way to get money to primary care immediately."
While 42% of primary care practices have sought and received some relief from the government or immediate prospective payments from insurers, 21% were ineligible for existing programs and didn't have any available options.
That leaves many of them in the lurch, with 57% reporting decreases in payments sufficient to care delivered, while 60% find less than half of their work reimbursed.
About 9% have received donations from patients interested in helping to save their practices.
"Primary care really is on the verge of collapse," said Etz. "COVID could well be an extinction-level event for primary care, and we will suffer dramatically if that happens because the healthcare system relies on primary care as its foundation. I feel like we're at that pivotal moment."
THE LARGER TREND
LRG Healthcare CEO Kevin Donovan said last week that the system got a $5.25 million loan from the state and $4 million in CARES Act funding, but it's nowhere near what the system needs. For it to have been enough, the government would have to inject about $10 to $12 million per month, which he said no one is expecting.
Meanwhile, the system has temporarily shut down programs and furloughed about 40% of its workforce.
The stimulus and emergency-response funding from the federal government will blunt some of the losses resulting in nonemergency and elective services, but hospitals won't be fully compensated, according to a Moody's report last week. Financial recovery from the public health crisis depends on restarting elective services, but the pace and timing with which that happens will vary greatly by geography, depending on when restrictions are lifted.
The United States now leads the world in confirmed coronavirus cases at 1,562,714 as of Thursday afternoon, according to Johns Hopkins University data.
The U.S. also leads the world in COVID-19-related deaths, at 93,863.