Coronavirus survey: Primary care practices face ongoing strain during pandemic

By Christopher Cheney

Primary care practices are continuing to struggle with the impact of the COVID-19 pandemic, a new survey indicates.

Drops in patient volume and increases in costs for infection control such personal protective equipment (PPE) have hit physician practice bottom lines hard during the pandemic. In the spring, a survey conducted by the Primary Care Collaborative and The Larry A. Green Center found only 33% of primary care clinicians had enough cash on hand to function for four weeks.

The new survey, which was conducted by the Primary Care Collaborative, The Larry A. Green Center, and 3rd Conversation, features information collected from more than 580 primary care clinicians in 47 states, the District of Columbia, and Guam. The survey, which was conducted from Oct. 16 to Oct. 19, has several data points that reflect the status of primary care practices during the fall stage of the pandemic.

• 60% percent of survey respondents reported seeing a rise in COVID-19 illness in their communities
• In a finding consistent with four other Primary Care Collaborative surveys conducted since August, about half of respondents reported the level of strain related to the pandemic as a 4 or 5 on a 5-point scale
• 56% of respondents reported an increase in health burdens among patients due to delayed or inaccessible care
• Only 16% of respondents reported that their practice had added capacity to help patients with mental or behavioral health conditions, despite an increasing burden
• Financial difficulties have eased at primary care practices, with only 6% of respondents reporting that they were unable to pay some bills
• 35% of respondents reported having difficulty hiring staff
• 27% of respondents reported permanently losing practice members, including to early retirement and illness
• 44% of respondents reported that it was taking more than two days to receive coronavirus test results
• 23% of respondents reported that inadequate supply of PPE or the necessity to reuse PPE made them feel unsafe

Interpreting the data

With many primary care practices under severe strain, their ability to play an active frontline role in distributing COVID-19 vaccines is in doubt, the survey authors wrote.

“Successful distribution of a COVID-19 vaccine will require a high functioning primary care platform, yet practices remain weakened by lost revenue, pandemic surges, and deteriorating patient health. It is urgent that public and private payers foster primary care stability by committing to prospective payments and maintenance of telehealth at parity with in-person visits until the vaccine is widely disseminated,” they wrote.

Ann Grenier, president and CEO of the Primary Care Collaborative, told HealthLeaders that primary care practices are facing daunting challenges during the fall coronavirus surge. “Many of us are very concerned about how the primary care platform will weather this surge. To date, they have proved resilient and innovative in their response to patient need. But both practices and patients are in a more compromised state as the survey shows.”

It is unclear how many primary care practices face existential threats, she said. “Unfortunately, we will know in the rear-view mirror. How many primary care clinicians retire or throw in the towel? How many decide to sell their practice? The primary challenges include lack of capital to weather the volume declines, a fee-for-service payment model that depends upon volume, and a tired and discouraged workforce—many of whom do not have access to basic pandemic supplies like PPE.”

There are two primary ways to bolster primary care practices during the fall coronavirus patient surge, Grenier said.

“Public and private payers need to come together and vow that they will not back away from payment parity for virtual and phone patient visits. In the middle of this surge, primary care should not have to worry whether they will be renumerated for doing their job of virtually triaging, managing, and educating patients who are scared. Prospective payments to shore up practices would also be incredibly valuable.”

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.