Primary Care Providers Blame COVID-19 for 'Severe' Strain on Practices

More than half (54%) of primary care practices are conducting the majority of their visits by telephone.

Nearly 8 in 10 primary care clinicians say their practice is under "severe" or "close to severe" strain because of COVID-19, with only one-third of respondents to a new poll this week reporting that they have enough cash on hand to last one month.

Of the 713 primary care physicians, nurse practitioners and physician assistants in 50 states and American Samoa who responded to the weekly poll from the Primary Care Collaborative and The Larry A. Green Center, 44% said the level of strain on their practice as "severe," and 35% said it was "close to severe."

The combined numbers are in line with a similar polls conducted by PCC and the Green Center last month. 

"The quantitative and qualitative results of these surveys are a clarion cry for more health plans to step up and cover telehealth and telephonic visits as Medicare has done," said Ann Greiner, president and CEO of the Primary Care Collaborative.

"Next is to get financial relief to practices that are going under water and to move primary care much more rapidly to adequate prospective payment," she said. "Practices under such arrangements can weather these storms and provide higher-value care."

Among the survey findings:

• Telehealth capacity is increasing, with 33% of respondents reporting that their practice had no video visits (down from 60% the week before), while half report no e-visits at their practice (down from 70% the week before).
   
• More than half (54%) of primary care practices are conducting the majority of their visits by telephone.
   
• Nearly a third of respondents work at practices that offer some visits in the parking lot.
   
• Only 33% of clinicians say they have enough cash on hand to function for four weeks.  Half answered either "no" (13%) or "unsure" (37%).
   
• More than 20% of respondents said their practice may temporarily close, owing to either "clinician or staff illness," (20% maybe); "lack of PPE/supplies (21% maybe); and "lack of revenue" (16% maybe).

The survey respondents represent a wide range of primary care providers, including family medicine (59%), geriatrics (13%), internal medicine (12%), primary care-based pharmacists and behavioral health (11%), and pediatrics (5%).

About 20% of the respondents work in small practices with three or fewer clinicians, 29% work in community health centers, 33% work in practices owned by an academic medical center, and 20% are self-employed.  Nearly one-quarter of the respondents practice in a rural setting, and about half of the clinicians said a majority of their patients are commercially insured.

"This week's survey shows that pressure on front-line clinicians is intense," said Rebecca Etz co-director of The Larry A. Green Center and associate professor of family medicine and population health at Virginia Commonwealth University.

"Practices are mostly holding on now, but in this week's survey, six in 10 clinicians said they were uncertain if their practice will be open a month from now due to the combined pressures of no PPE, clinician and staff illness, and lost income," Etz said.