As COVID-19 cases continue to rise in parts of the U.S., many primary care practices are not ready to address the current surge or a second wave predicted to come in the fall.
According to the Kaiser Family Foundation, 26 states had 14-day upward trends in cases and positivity rates on June 25.
At the same time, practices are reopening to in-person visits in all parts of the U.S. while primary care doctors are feeling uncertainty over the duration and severity of the COVID-19 pandemic and the impact on their practice, according to a survey of 730 primary care clinicians in 49 states and Washington, D.C.
Alarmingly, nearly half of practices continue to lack personal protective gear (PPE), and 25% say local labs are struggling to keep up with COVID-19 testing demands, according to the survey from the Larry A. Green Center in partnership with the Primary Care Collaborative and 3rd Conversation that was conducted June 26 to June 29.
When asked to look ahead to the next six months and evaluate their practice’s readiness for changes in patient volumes and payment policies, more than 30% of primary care physicians feel unready or “spent” from the demands of the pandemic. More than 40% feel unready for another wave.
At the same time, health burdens from chronic disease are on the rise, with 56% of clinicians reporting that patients are requiring more care as their existing health issues are exacerbated by lack of access during the pandemic.
“This is disaster recovery 101. As a nation, we needed to look at the gap analysis from day one, figure out where our weaknesses lie, and work to address them so we are not as vulnerable next time. However, we’ve failed to do that,” said Rebecca Etz, Ph.D., co-director of The Larry A. Green Center in a statement.
“We already have had preventable patient morbidity and mortality. It’s shocking to see that half of practices say if things do not turn around it is likely they will not be here at the end of the year," Etz said.
The pressures on primary care practices are multifaceted, the survey found. Close to half (45%) of practices don’t have PPE and 61% are reusing PPE although the U.S. Food and Drug Administration reports this practice being unsafe for some PPE types.
Fewer than 50% of practices report having enough cash on hand to stay open, over one-third have laid off or furloughed staff in the last four weeks, and 53% report that patients are not scheduling well visits or chronic care visits despite their availability in the practice.
"While new federal, state and health plan virtual health policies have helped primary care, these turn out to be necessary, but not sufficient support,” said Ann Greiner, president and CEO of the Primary Care Collaborative in a statement.
Nearly 70% of practices are not ready for reduced or terminated payment for audio and video visits, the survey found. The Centers for Medicare and Medicaid Services (CMS) made sweeping changes to telehealth reimbursement, but these changes will terminate when the national emergency is declared over unless Congress acts to extend payments.
Only 17% of practices expect to receive prospective payment from any payer in the next four weeks, indicating how dependent practices continue to be on fee-for-service revenue.
A primary care physician in New York said in the survey, "I doubt independent primary care can survive without a large increase in pay for service."
More financial support from the Provider Relief Fund also is needed as is testing and PPE, Greiner said.
"You can draw a straight line between lack of primary care support and bad patient outcomes, particularly for patients of color," Greiner said.
The current surge is a preview of what’s to come during the impending second wave, said Christine Bechtel, patient advocate and co-founder of 3rd Conversation.
"Anyone—whether a policymaker, an insurer or patient—should be totally alarmed. This data tells us that we are in deep trouble. I don’t know how much longer we can shout at the wind, but I’ll say it again: Health care is only going to get more expensive and less available from here on out unless policymakers and insurers act fast to prevent even larger economic and health catastrophes resulting from the imminent collapse of primary care," Bechtel said.
According to the survey, a primary care physician in Pennsylvania said, "We are starting to see more patients in the office to accommodate their needs now that PA is in the green phase, yet the cases in our state are starting to increase again … I am worried about the fall and winter surge. We have no plan in place to address this. No access to N95."
The physician said all the providers in the office continue to take pay cuts.
"Primary care continues to be forgotten, especially privately-owned practices, yet we are vital to the medical care of our communities," the doctor said.