Primary Care Is Staying Open, But Practice Management Issues Persist

Practice management issues remain even though significantly more primary care clinicians are confident their practices can stay open over the next four weeks, according to the latest survey from The Larry A. Green Center and the Primary Care Collaborative.

The Week 19 survey was fielded August 21 through 24, 2020. Out of the 636 responses received from primary care clinicians, 89 percent indicated a sense of confidence in their practice’s ability to stay open over the next four weeks.

The finding is in stark contrast to survey results from earlier during the pandemic when one in five clinicians expected their practice to close.

The renewed confidence in practice stability is good news for primary care, which has been wrought with financial and operational struggles since communities implemented shelter-in-place orders, resulting in large-scale appointment cancellations and delays.

Financial support from the CARES Act, Paycheck Protection Program, Small Business Administration, and government agencies – which 44 percent of clinicians say their practice has gotten – has helped primary care providers weather the storm.

And despite frustrations clinicians have reported throughout the public health emergency, about 66 percent of those responding to the latest survey said they are not considering leaving primary care.

However, practice management issues are still threatening financial stability and even care quality, the survey showed.

Over the past four weeks, nearly half of clinicians (47 percent) said they had other providers and/or staff out due to illness or self-quarantine and 21 percent reported having to lay off or furlough employees.

About 28 percent of clinicians also said they have experienced a 30 to 50 percent drop in fee-for-service revenue in the last four weeks compared to pre-pandemic levels. About 46 percent have seen a similar decrease in patient volume.

Additionally, 34 percent of clinicians said they had to reduce the number of services offered to patients, while 34 percent have pulled back on or eliminated educational training and 24 percent shutdown quality initiatives from before the pandemic.

The findings show how primary care is dwindling in size, resilience, and resources even though many practices are staying open, researchers from The Larry A. Green Center and the Primary Care Collaborative said.

“[P]rimary care is shrinking at precisely the time it is needed to help the country get back on its feet,” the groups stated when announcing the survey’s results.

In the past month alone, 2 percent of practices have closed, another 2 percent are considering bankruptcy, and 10 percent are uncertain of their solvency for the coming month, they reported.

“Previous federal and commercial efforts have provided time-limited, modest support that is not enough to help sustain primary care practices and enable them to meet myriad COVID-19 challenges,” they added.

One of those challenges is increased health burdens.

Clinicians responding to the latest survey reported higher stress and pressures on their patients, including higher levels of mental health concerns (86 percent), more sleep issues (77 percent), weight gain (73 percent), and an overall reduction in self-care (57 percent).

In addition, 34 percent of clinicians experienced a higher level of food insecurity among patients and 38 percent experienced higher levels of housing insecurity. Over half (58 percent) said their patients are struggling to pay bills.

Primary care providers are well-positioned to handle these issues, with three in four clinicians saying they are able to assist patients with mental health concerns.

About 15 percent of clinicians also said their practice has become more involved helping with housing security, while 17 percent have become more involved helping with food insecurity and 26 percent have offered support or extensions for healthcare bills.

But primary care practices are doing this without additional resources, experts from The Larry A. Green Center and the Primary Care Collaborative said.

“Clinicians’ workloads have increased, environmental threats have increased, and they are trying to address social issues that contribute to health inequities. And still, we watch them fall. When will policy makers acknowledge primary care is too critical to collapse,” asked Rebecca Etz, PhD, co-director of The Larry A. Green Center.

Payment reform may be necessary to save the already shrinking primary care workforce.

Etz told RevCycleIntelligence earlier during the pandemic that practices receiving more than half of their income for primary care based on a prospective, capitated payments have fared better than their fee-for-service peers during the pandemic. This is because capitated payments are a “dependable revenue stream that allows them to do what primary care does best, which is to meet patients when and where they need through whatever modality,” Etz said.

In previous survey reports, Etz’s colleague at the Primary Care Collaborative advocated for telehealth payment parity.

“Given the rapidly rising infection rates and persistent lack of PPE, more than a third of primary care clinicians are reporting feeling unsafe at the office, and 20% are cutting back on face-to-face visits while doing more remote outreach,” Ann Greiner, president and CEO of the Primary Care Collaborative, said regarding the Week 16 survey.

“This is a clear signal that all payers must advance or retain parity for telehealth and telephonic calls. But it also is a clarion call to move to a new payment system that doesn’t rely on face-to-face visits and that is prospective so practices can better manage patient care,” Greiner stated.

Few clinicians earn primary care income based on capitated payments but industry experts are saying that COVID-19 could be the catalyst for increased adoption.