The COVID-19 pandemic’s disruption of primary care could affect access to care as modeling through June shows a potential loss of 60,000 PCPs

• Primary care physicians have been particularly challenged by the COVID-19 pandemic’s disruption of the healthcare delivery system. Even prior to the pandemic, primary care providers were experiencing issues related to access, burnout and rising practice costs.
• In March, the COVID-19 pandemic caused a nearly 60% reduction in office visits as a result of social distancing practices.
• Modeling though end of June illustrates the potential economic impact of PCP practice closures across the country, with predicted loss of nearly 60,000 primary care practice physicians and nearly 800,000 jobs.

The COVID-19 pandemic’s disruption of the healthcare delivery system has been particularly challenging to primary care. Prior to the pandemic, primary care providers were already experiencing issues related to access, burnout and rising practice costs that were unsustainable. In March, the COVID-19 pandemic caused a nearly 60% reduction in office visits as a result of social distancing practices.

Providers were forced to shift care to phone consults, often non-reimbursable, and swiftly find alternative ways to manage patients. As a result, practice revenues dropped while simultaneously being tasked to ramp up telehealth visits to maintain operations. In doing so, practices were challenged with changing workflows, learning new billing, coding and documentation practices and implementing platforms for telemedicine — all while facing decisions to cut or furlough staff.

The impact of telehealth

Prior to the pandemic, telehealth adoption was slow. Some primary care providers viewed telehealth as a poor substitute for an in-person visit and wprimary-health-careere hesitant to invest in the technology required. Telehealth visits were reimbursed at a much lower rate than in-person visits and not considered a viable option.

However, many chronic conditions such as diabetes and hypertension can be managed effectively through televisits or phone visits, and remote monitoring can be a viable option for managing higher acuity care through models such as hospital at home.

A recent Health Affairs blog summarizes the value of primary care and the promise of shifting more care to distance or telehealth visits. Primary care provides frontline interventions and the gateway to the healthcare system. The benefits of a substantial primary care workforce include not only diagnosing, treating the general health risks of populations but also are associated with reducing total healthcare costs, lower hospital admissions and decreased mortality.

The pandemic has begun to break down the cultural, administrative and financial obstacles to telehealth. And CMS has helped to facilitate this by offering temporary parity in telehealth payments, however its uncertain if these rates will be reduced once the pandemic subsides (although there are promising signs). 

Despite this, much of the federal aid provided to the healthcare system is based on fee-for- service (FFS) Medicare dollars. Primary care practices that saw higher Medicaid populations or other non-Medicare patients did not receive adequate aid (though some accessed financial support through the Paycheck Protection Program or Small Business Administration loans).

Many practices will not recover. Modeling though end of June illustrates the potential economic impact of practice closures across the country with predicted loss of nearly 60,000 primary care practice physicians and nearly 800,000 jobs resulting in significant shortages in areas.

Short- and long-term payment model changes

Payment model changes are necessary to revive, support and strengthen primary care. A couple of quick fix options are:

• Continued parity from CMS in telehealth payments
• More support from private health plans. As described in this Health Affairs article, potential shortages in primary care could increase costs as patients would seek more care from higher costs specialists, and weaken their health plans’ ability to maintain higher value networks of care. Private insurers should take note. One option proposed is a temporary increase to primary care reimbursement by a factor of 1.5, while still maintaining an FFS payment structure.

Longer-term strategies could include:

• More global payments. About 6% of total spending of health services represents payments to office-based primary care physicians. Allocating these dollars to physicians, allowing them more flexibility in care models and decreasing administrative requirements would improve financial sustainability and allow physicians more ownership in the cost and models of care, and improve clinician satisfaction. 
• Movement toward more alternative models such as direct primary care (DPC), or direct-to- employer contracting or models such as CMMI’s Primary Care First. Similarly these models could empower physicians with more freedom in managing patient care via telehealth and multi-disciplinary teams, an ideal approach to primary care.