Financial troubles for primary care providers are being keenly felt by patients, with most saying their clinic’s closure would be a disaster for the strong patient-provider relationship so many credit for their wellness, according to the latest from the Primary Care Collaborative, the Larry A. Green Center, and 3rd Conversation.
The week 11 poll tracking the state of primary care throughout the novel coronavirus pandemic looked at both patient and provider sentiment. The survey asked respondents about the risk to primary care and how it has impacted patients, and how it may continue to do so moving forward.
This comes as the financial threat to primary care provider offices draws nearer. As a result of the novel coronavirus, the number of patients visiting primary care has tanked. Per the week eight survey from PCC and the Larry A. Green Center, 70 percent of primary care providers have seen patient volumes decrease.
And as a result, profit margins are shrinking. That same PCC and Larry A. Green Center survey showed that about a fifth of primary care offices are closing, while more are furloughing staff and bleeding profits.
At the time of the week eight survey, providers expressed concerns that these new primary care challenges were going to have an adverse impact on patients, with most agreeing outcomes would suffer. Others expressed concerns about patient trust in medicine, especially their primary care providers.
This latest survey serves up good and bad news for those concerned providers. The questionnaire, which yielded 2,250 adult patient responses, showed that patients trust and have great relationships with their primary care providers. The primary care office has been a great source of help during the COVID-19 pandemic, with patients reporting strong outreach on the part of their PCPs.
And it’s for that very reason patients are just as concerned as their clinicians.
Eighty-three percent of patients said it would be distressing to see their primary care clinics shut down, impairing a longstanding patient-provider relationship.
Currently, about three-quarters of patients are reporting strong outreach on the part of their primary care providers. For those patients, any contact they have had with their PCPs has been the result of outreach initiated by the primary care office. Two-thirds of respondents said their providers helped them make sense of what is going on with COVID-19.
“At a time when mistrust of institutions is at an all-time high, 70% of patients report feeling secure in their trust of primary care,” said Ann Greiner, president and CEO of the Primary Care Collaborative. “Primary care is central to helping patients navigate this crisis right now. It will be essential in the months ahead as states begin to re-open and Americans turn to trusted sources to help them transition back to work and school.”
Meanwhile, concerns about delayed healthcare access abound not just among providers, but patients as well. Seventy percent of primary care providers are delaying access to treatments in an effort to cap COVID-19 spread; 83 percent of patients are delaying access on their own, primary care offices have reported.
Patients corroborated those reports in this latest survey. About one-quarter of respondents said they had fallen ill since March’s stay-at-home orders, but did not visit the doctor. Forty-two percent said they will access care should symptoms grow dire.
For what it’s worth, separate reports indicate that may not happen. Emergency department volume is down, with fewer patients presenting with life-threatening symptoms of heart attack or stroke. This comes as the rate of patients dying at home has increased in recent months.
These missed visits are starting to pile up, the PCC, 3rd Conversation, and Larry A. Green Center data continued. About one-fifth of patients said they are overdue for a chronic care check-in, while half are overdue for a wellness check or preventive visit.
Of course, health IT has stepped in to fill in some of these gaps. Notably, telehealth has been lauded as critical to continuity of care during COVID-19.
But there have been challenges there, too. Twenty-nine percent of patients said they do not have the broadband connectivity to have a telehealth visit, and another 28 percent said they do not have a tablet or computer at home that can support a telehealth visit.
And the proof is in the pudding. Over half (58 percent) of the telehealth interactions that patients reported only used phones. Twenty-seven percent of practices reported no use of video visits.
There is a financial component at play, as well. Thirty-eight percent of PCPs said the telehealth they have delivered is not able to be reimbursed by a public or private payer (the report did not specify).
This further exacerbates the dire financial situation plaguing primary care providers across the country.
“The COVID-19 pandemic has put our chronic underinvestment in primary care on full display,” said Dr. Rebecca Etz, PhD, co-director of The Larry A. Green Center and associate professor of Family Medicine and Population Health at Virginia Commonwealth University. “Without immediate financial support, we are looking at a matter of weeks – not months – that patients’ fears about primary care will turn into reality.”
Thirty-eight percent of providers reported getting a Paycheck Protect Program loan, and 12 percent got another small business loan. Eight percent said their local government gave them a loan, while 10 percent said they got a loan from a primary care parent organization.
Nevertheless, the situation is bleak. Forty-five percent of organizations are furloughing staff while 28 percent of organizations have some employees skipping paychecks. Fourteen percent are temporarily closed.
With patient volumes down, clinics are unable to keep the lights on. But paradoxically, without the lights on, clinicians cannot meet patient healthcare needs.
“By any traditional business metrics, thousands of primary care practices should be closing their doors right now – but they stay open for us, their patients,” said Christine Bechtel, patient advocate and co-founder of 3rd Conversation. “The fact that, in the middle of a pandemic, our health professionals are struggling to keep their doors open is not just a frightening prospect, it is unacceptable. Lawmakers must act to provide immediate relief targeted to primary care practices,” she concluded.
Mental health issues are also starting to compound, with over half of patients saying they are feeling the effects of social isolation and 48 percent feeling exacerbated depression or anxiety.