First, the good news.
Primary care practices showed nimbleness as small businesses, such as by quickly shifting to telehealth services, in the face of historic challenges posed by the global pandemic, according to a new policy brief published by the Urban Institute.
Doctors also indicated they aren't planning on going anywhere despite the financial and logistical challenges they've faced in the last year and, if anything, have been steeled by their commitment to their work. "COVID made me realize I can’t retire. I’m like the glue that keeps it all together," one doctor told researchers examining the impact of the first year of the COVID-19 pandemic on primary care practices across the U.S.
But, the industry is going to need ongoing—and better targeted—support as the nation enters its second year of responding to the health crisis, researchers said in the policy brief funded by the Robert Wood Johnson Foundation.
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In particular, they said, future iterations of federal funding support should be better targeted to support providers in the most need. Many practices may need support for general operating expenses after experiencing lagging patient demand for well visits and other elective services, they wrote. "Although federal financial assistance and the increased use of telehealth helped many practices stay afloat in 2020, current trends in virus transmission will continue to put financial and safety pressures on primary care practices," they wrote. "Additional federal support is likely needed, at least in the short-term, to ensure continued access to sufficient PPE and adequate reimbursement for services delivered via audio and video technology."
Practices indicated much of the support they received was from their communities, but they would benefit from more support from payers.
In one case, a Virginia primary care practice said an insurer offered financial help but only on the condition the practice refrain from being acquired by a hospital or larger physician group for a number of years. However, in other cases, practices said insurers did offer valuable assistance, such as continuing to pay for telemedicine services at parity with in-person services, even though the state mandates no longer required it.
Practices also indicated a new willingness to enter into capitated payment arrangements with payers in order to avoid the financial uncertainties of fee-for-service should utilization once again be suppressed, researchers wrote.
And, while there were a number of supports for practices, they lacked a national blueprint or protocols for the best way to respond to a pandemic. Primary care groups had to implement creative changes to the way they do business, the researchers wrote.
"In large part, PCPs’ response to COVID-19 was a bottom-up process, with PCP practices making mostly independent, rapid, and varied decisions to fundamentally shift the way they deliver care," the researchers wrote.