US primary care practices are projected to lose more than $65,000 in revenue per full-time physician in 2020, following drastic declines in office visits and fees for services from March to May during the COVID-19 pandemic, according to a study led by researchers in the Blavatnik Institute at Harvard Medical School.
The lost revenue adds up to a shortfall of $15bn to primary care practices across the US, according to the analysis. The researchers also caution that losses would balloon substantially if there is a second viral peak later in the year or if the reimbursement rates for telehealth visits revert to pre-COVID levels.
The study was led by Sanjay Basu, director of research and population health at Collective Health and a faculty affiliate in the HMS Centre for Primary Care, Russell Phillips, director of the centre and professor of global health and social medicine at HMS, and Bruce Landon, HMS professor of health care policy.
“For many primary care practices, particularly those serving the most vulnerable populations, these losses could be catastrophic, with many practices being forced to close,” Basu said. “This could weaken the US health system dramatically at a time when we need it to be at its strongest.”
“Our prior work shows that primary care saves lives, and loss of primary care practices will translate to lives lost across the US,” Phillips said.
To calculate the projected financial losses on operating expenses and revenues, the researchers simulated the impact of the pandemic on a variety of practices analysing both visit volume and visit type, among other variables. They then compared the anticipated revenues, expenses and losses under several scenarios, including a second shelter-in-place order in November and December as well as reverting back to the significantly lower pre-pandemic levels of provider reimbursement for tele-medicine visits.
Once the most acute threat of COVID-19 subsides and the pandemic winds down, primary care in the US will have to absorb the brunt of long-term COVID-19 care and management, testing and vaccination, the team said. The primary care system must also be equipped to meet the piled-up needs of the population and return its attention to the major chronic medical conditions that collectively will determine the health of Americans for many years to come, they said.
“The coronavirus pandemic highlights the fragility of the primary care system,” said Landon, noting that “over half of primary care practices remain small and physician-owned and these independent practices have limited access to capital and other support that could help them weather the pandemic.”
The researchers said their findings and the looming growth in primary care use underscores the need for a financial boost to the primary care system.
“The coronavirus pandemic is a pointed reminder of the importance of primary care to our society. Primary care is critical to limiting the spread of the virus, in treating the comorbidities that can make COVID-19 so deadly and in helping people navigate the social and psychological challenges of social distancing and of living with the pandemic,” Phillips said.
While legislation proposing financial aid to hospitals has already been introduced in Congress, independent primary care practices have yet to receive significant financial help, the researchers said.
Additional collaborators on the study include colleagues from the American Board of Family Medicine.
Due to the novel coronavirus disease (COVID-19), virtually all in-person outpatient visits were cancelled in many parts of the country between February and May 2020. We sought to estimate the potential impact of COVID-19 on operating expenses and revenues of primary care practices.Using a microsimulation model incorporating national data on primary care utilization, staffing, expenditures, and reimbursements, including telemedicine visits, we estimated that primary care practices over the course of calendar year 2020 would be expected to lose $67,774 in gross revenue per full time physician (the difference between 2020 gross revenue with COVID-19 and the anticipated gross revenue if COVID-19 had not occurred, interquartile range: –$80,557, –$54,990). We further estimated that the cost would be $15.1 billion at a national level to neutralize the revenue losses caused by COVID-19 among primary care practices. This could more than double if COVID-19 telemedicine payment policies are not sustained. [Editor’s Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.]
Sanjay Basu, Russell S Phillips, Robert Phillips, Lars E Peterson, Bruce E Landon
Harvard Medical School material
Health Affairs abstract