Large hospitals and medical practices have remained afloat by segregating coronavirus testing and treatment from other medical services. But an astounding number of smaller practices, specialists, and primary care practices have simply been unable to do so, given the physical and practical realities of pandemic preparedness.
Early on in the coronavirus outbreak, health officials warned that if any member of a medical staff accidentally came into contact with a patient who later tested positive for the coronavirus, the entire staff would have to self-quarantine for a fortnight, effectively shutting down their practice. Between the improbability of properly siphoning off those with the risk of testing positive and the legal liability of testing, vast swaths of our healthcare professionals are out of business when we need them the most.
In the very, very long run, it’s possible that the coronavirus will inadvertently force the primary care industry to adopt the more stable and efficient model of consumer-funded direct primary care models by virtue of the pandemic expediting the demonstration of our insurance model’s failures. But in the short run, the crises faced by the primary care industry could result in a bloodbath independent and longer lasting than the coronavirus.
In a national survey conducted by the Primary Care Collaborative, a staggering 1 in 5 practices reported predicting closure within four weeks, and nearly half reported layoffs and furloughs or skepticism of whether they have enough cash to remain viable financially.
This is partially due to factors wholly out of anyone’s control. The majority of practices report having at least one patient unable to take advantage of telehealth, and 12% of practices predict they’ll close because of low patient volume, which is likely caused by individuals fearful of seeking regular care with the risk of contracting the coronavirus.
But a significant portion of these predicted closures are direct results of policy failures. Forty-two percent of practices report not using e-visits and 28% report not using patient portals, a fact almost surely caused in part by the federal government’s onerous regulations on electronic medical records and communication.
The laws surrounding electronic medical records and telehealth have long been a nightmare. Barack Obama himself has admitted that the Affordable Care Act’s electronic medical records provision has proven the most disappointing aspect of the bill. But the coronavirus has just proven that even with the Trump administration’s relaxation of telehealth regulations, that bad government policy prevented practices from even trying to set up the infrastructure for remote care.
Another aspect of policy has also kneecapped telehealth: insurance reimbursement. Ten percent of practices reported not receiving payment for telehealth, and another 16% reported not receiving payment for phone care. Physicians treat patients over the phone for free all the time. But when 85% of practices report “dramatic decreases in patient volume,” and rent is still due every month, physicians are stuck digging through the couch cushions for enough change to keep the lights on. And given the reality of contemporary primary care, this just isn’t tenable.
Primary care physicians earn orders of magnitude less than many specialists despite working a comparable amount of hours. New practices usually take years to even begin to break even, and even then, owners strategize in terms of baseline profitability, not profit margins. Even without a pandemic, we can trust that once a lot of these practices close, they’ll be gone for good. But the coronavirus has already exacerbated our national financial system’s credit drain. By the time the healthcare world stabilizes long enough for doctors to want to brave recreating their practices, how many banks will be willing to foot the initial bill?
Again, in the long run, this could be ameliorated by individual physicians converging to cut out the insurance cartel and create direct primary care models funded by flat subscription fees from patients. But in the short run, how many patients will forgo cheap but long-term cost-saving care such as chronic condition treatment or annual cancer screenings? And even worse, how will this exacerbate the coronavirus’s racial effects? Already 12% of clinics report disparities among racial minorities, and we know that the coronavirus has hit black Americans the worst. Could the collapse of hundreds of primary care practices further compound this?
Restaurants and retailers shutting down and tens of millions of people losing their jobs is already a First World catastrophe. But a resurgence of totally preventable deaths from untreated heart disease to HPV spiraling into cervical cancer amid a national healthcare shortage, especially one disproportionately killing the already disadvantaged, would be an apocalyptic nightmare of another degree.
