Primary care doctors fear delayed care will lead to serious illnesses, death

More than a third of primary care clinicians fear their patients will die because of delayed care during the COVID-19 pandemic.

There is an emerging concern that delayed healthcare likely due, in large part, to stay-at-home restrictions will lead to serious and sometimes fatal repercussions for patients over time, according to a survey of 750 primary care clinicians in 49 states and Washington, D.C.

Clinicians predict primary care will be overwhelmed with pent-up demand, and more than 60% of responding clinicians believe that some of their patients will experience avoidable illnesses due to either diverted or avoided care, according to the survey from the Larry A. Green Center in partnership with the Primary Care Collaborative that was conducted May 1-4.

Two-thirds of respondents say they fear parts of the country will be opened too early, intensifying a second wave of COVID-19 and prolonging the strain on the healthcare system. 

The latest survey also found that primary care clinicians continue to face considerable headwinds.

More than half of primary care practices are still lacking adequate personal protective equipment (54%) and testing capabilities (54%), and a staggering 70% of clinicians report that they have seen a significant decrease in patient volume, which is threatening their practices’ financial viability. 

Slight financial improvements may be emerging. In this latest survey, 49% of clinicians report that over half of their visits were reimbursable, compared with 34% in last week's survey.

RELATED: CMS eases requirements for COVID-19 tests, boosts payments for telephonic visits 

"It has been the most stressful time of my 20-year career. Trying to care for patients with high-quality care, provide a safe environment for our staff, and maintaining a financially viable practice. Very much considering leaving clinical medicine," one primary care physician in Colorado said, according to the survey.

“As state and national leaders discuss opening the country, primary care clinicians worry that they stand alone and ignored, lacking sufficient funding as well as the testing capacity and PPE necessary to support and treat the population,” said Rebecca Etz, Ph.D., co-director of the Larry A. Green Center and associate professor of family medicine and population health at Virginia Commonwealth University. "Clinicians are worried about a wave of patients with currently unmet health needs arriving just as their practices are starting to fail.”    

Ann Greiner, president and CEO of the Primary Care Collaborative, said public-private efforts to bolster primary care have been like "bringing an umbrella to an oncoming hurricane and assuming you won’t get drenched."

"These efforts have been nowhere near enough in size, scope, reach, or level of multi-payer participation. Policymakers must immediately target relief directly to primary care practices to stabilize them," Greiner said.

RELATED: Physician groups concerned about financial shortfall for treating patients with complex health needs

A primary care physician in Texas said, "PPP (Paycheck Protection Program) loans are incredibly slow to come through and might not arrive in time to cover April payroll needs."

Concern for patients’ mental health needs, both now and post-pandemic, is mounting. Just under a third of clinicians expect to see a dramatic increase in the prevalence of substance abuse among their patients, and 74% expect to see an increase in patients with mental health needs. 

A quarter of primary care physicians expect to see dramatic increases in domestic violence among their patients.

Many clinicians also believe a new primary care landscape—one with few independent practices—may emerge post-pandemic. Over a third of respondents (35%) believe the majority of independent primary care practices will be gone by the time the pandemic ends stemming from the financial repercussions of COVID-19.

Clinicians also fear that patients’ trust in the healthcare system is eroding. A quarter of primary care physicians say that they anticipate the pandemic will result in "a broken sense of trust between the public and the medical world."

Virtual health has expanded rapidly as a patch fix, but some challenges are beginning to show, according to clinicians.

RELATED: Primary care practices struggle with inconsistent payment for telehealth, still lack testing, PPE

The Centers for Medicare & Medicaid Services (CMS) made sweeping, but temporary, changes to telehealth reimbursement policies and agreed to pay for virtual visits at the same rate as in-person visits while the coronavirus emergency remains in effect. As of March 30, CMS is now allowing more than 80 additional services through telehealth.

"It has been more difficult to connect to 'underserved' patients with limited ability to manage virtual care. These relationships are stressed, and trust may erode if we cannot adapt to better serve them," a Michigan-based clinician said.

A Georgia clinician responded, "Rural area with unreliable internet in many locations, an aging population with some difficulties with technology, and a great number of residents in the area living below the poverty level making the internet a luxury."

Many clinicians (60%) believe that policies changed to support primary care during COVID-19 will be reversed once the pandemic lessens.

The majority of clinicians who responded to the survey (60%) work in a practice with fewer than 10 clinicians. Nearly a quarter work in rural practices, 18% at a community health center and 9% at a convenience care setting. Over half (58%) have a patient pool in which more than 10% are Medicaid beneficiaries.