Primary care docs strained by vaccine hesitancy, potential telehealth rollback as COVID-19 pandemic drags on

Despite heightened demands during the COVID-19 summer surge, primary care clinicians remained resilient, often turning to telemedicine amid efforts to maintain patients’ access to care.

Clinicians reported that patients’ needs surpassed pre-pandemic levels. For almost two-thirds of clinicians—64%—telemedicine proved to be a major asset in preserving their ability to serve patients, according to a recent survey.

“Primary care is the proverbial front door of the health care system, and it is where most people get their care,” Ann Greiner, president and chief executive officer of the Primary Care Collaborative told Fierce Healthcare. “It’s important to have an ongoing way to assess how that platform is doing because it’s so foundational to the health care system.”

Greiner added that “COVID-19 has been challenging for all kinds of folks in the health care system, including primary care. The survey from the summer surge shows that primary care is flexing in all kinds of ways to serve its patients. The platform is being challenged, and there are a lot of issues.”

The survey was undertaken Aug. 13 to 17 by the Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, a thought collective, in conjunction with the Primary Care Collaborative, a nonprofit multi-stakeholder membership organization. The latest and 30th round of this ongoing survey since March 2020 pooled a total of 1,263 respondents from 49 states, Washington, D.C., and two territories.

RELATED: ATA urges HHS to protect telehealth coverage by extending public health emergency through 2022

Although primary care has been highly dependent on telehealth, the surveyed clinicians voiced concerns about its ongoing frequent use. If pre-pandemic payment regulations are reinstituted, 41% of clinicians fear their practice won’t be able to offer virtual care.

Losing this adaptive tool would pose another conundrum for an already overwhelmed workforce confronting multiple challenges. More than half of survey respondents cited mental exhaustion as a persistent concern while grappling with both COVID-19 and patients’ health needs during the virus’ summer surge.

Department of Health and Human Services (HHS) Secretary Xavier Becerra extended the public health emergency, which provides telehealth reimbursement flexibilities, through Jan. 16, 2022, the sixth renewal since the PHE was first declared in January 2020. But no further indications about the long-term status of the PHE have come from the agency.

The American Telemedicine Association (ATA) is urging the Biden administration to extend the COVID-19 public health emergency through the end of 2022 to protect telehealth coverage expanded during the pandemic.

The report included direct comments from clinicians on the front lines. For example, a clinician from Wisconsin wrote that “relationships allow me to even have a shot at getting hesitant patients to accept the vaccine. These conversations are exhausting and demoralizing.” A clinician from Kansas noted being “amazed that they (patients) can trust us to care for them in every way except believing us about the vaccine to protect them. They trust non-medical political sources.”

RELATED: Docs press CMS for permanent telehealth flexibility, relief from pay cuts in fee schedule

Meanwhile, a clinician from Illinois remarked that “burnout and a sense of hopelessness and compassion fatigue is escalating as this next COVID surge continues. We thought there was light at the end of the tunnel once the vaccine was available, but the pandemic continues to escalate.”

A clinician in New York cited an “explosion of mental health needs for patients, clinicians and staff. Limited resources to keep up. Everyone is struggling, including our behavioral health clinicians.” And a clinician in Colorado reported that “the rising cost of supplies—gloves, masks, etc.—without a commensurate rise in reimbursement, is putting a significant financial strain on our small, privately owned practice.”

Rebecca Etz, Ph.D., co-director of The Larry A. Green Center and a professor of family medicine and population health at Virginia Commonwealth University in Richmond, lamented the lack of cash infusion and echoed clinicians’ concerns over future payment.

“Primary care tended to the health needs of the nation during the pandemic and continues to do so,” Dr. Etz, a cultural anthropologist, said in a statement. “Despite poor resources, a shrinking workforce and the growing complexity of health burdens of patients, primary care expanded its services to provide the safety net so many were lacking. When will this nation—and its leaders—wake up to the fact that primary care is key to getting us out of this prolonged pandemic?”
The survey delved into the mounting pressures of delivering care during the summer surge. More than 7 in 10 clinicians—71%—said patient visits were more complex and required additional time; 54% reported being unable to hire staff for available positions in their practice and 45% acknowledged personally knowing primary care clinicians who had opted for early retirement or left their jobs due to the pandemic.
On the subject of COVID-19 vaccines, 52% of clinicians said two to three discussions were necessary to persuade vaccine-hesitant patients, with every conversation taking several minutes. More than two-thirds of clinicians—67%—said a gut or political opinion was the deciding factor for most vaccine-hesitant patients and could not be swayed.

RELATED: Practices facing 'existential' threats, uncertainty about future of primary care, survey finds

Clinicians were moderately successful in administering COVID vaccines. Nearly 6 in 10—59%—said patients were requesting a third vaccine dose, about one in three—34%—found more patients asking for the vaccine due to fear of the delta variant, and more than half—51%—said their practice had a sufficient vaccine supply. But less than a third—31%—said vaccinating patients was common in their practice as part of routine care.
Of the survey respondents, the majority (72%) said they work in family medicine.

“We are calling upon public and private payers to step up to help meet patients’ needs and safeguard the primary care workforce,” Greiner of the Primary Care Collaborative said in a statement. “Left with the most difficult-to-vaccinate portion of the population, primary care clinicians must be adequately supported for the multiple conversations that are needed to counter vaccine hesitancy and help meet our country’s vaccine goals.”