Is this the end of the independent physician?

May 6, 2020
Shawn Morris
Shawn Morris

Primary care providers will soon return to their post as the essential frontline team to test and treat patients, and to help ensure the safety of our communities.

When we look back on this time, 5, 10, 20 years from now, will we remember fondly the era when the American patient still had a trusted primary care physician? Will that seem like a quaint relic of the pre-coronavirus era? Unfortunately, that is a real possibility if our independent physicians continue to weather this storm without comprehensive support from our government and commercial payers.

The hospitals that are collectively fighting this global pandemic deserve all of the financial support that has been pledged thus far by the government and other commercial health insurers. As an industry and a country, we were unprepared for a virus of this scale to hit our nation, and the providers on the frontlines need every ounce of support, in dollars, supplies, and in the 7 p.m. cheering that takes place across the country.

Yet, we should not underestimate the great, knee-wobbling impacts the pandemic has had on the healthcare industry, most acutely felt by the nation’s traditional front-liners in primary care: within, the plight of the independent physician has never been so stark.

As the CEO of one of the largest independent physician organizations  in the country, we are in full protection mode of this cornerstone of American healthcare, as COVID-19 has changed everything for these pillars in our health system. Most pressing of course is protecting the future of primary care practices and the independent physician given the financial crunch this cohort faces after just 5-6 weeks of COVID-19 driven business contraction. The American Academy of Family Physicians projects that up to 60,000 primary-care practices may close between now and the end of June.

To illustrate, let’s compare to the prototypical small business – your local restaurant. While physician offices and restaurants are rarely considered in the same vein, even the best operators across both are experiencing transactions decline in excess of 50% and making business model changes that keep them active, but at greater cost to the franchise, like delivery or telehealth. Both industries must battle a double threat to survive: decreased volumes and increased operating expenses. You could in many ways review the recent financials of any primary care group and just as soon believe you were looking at your favorite neighborhood restaurant. This burden of lighter sales and less dollars per sale, coupled with the rapidly changing reimbursement issues and investment costs (investing in and turning on telehealth, for instance), is the business of medicine’s potential prescription for failure.

While providers are some of the biggest champions of the shelter-in-place orders, this has been crippling to our businesses. Much like local restaurants and other businesses that found their healthy balance sheets wiped out in the blink of an eye, independent physicians have similarly found themselves needing to reinvent their business models overnight. Strategically, my organization has long championed virtual health and through around-the-clock support of our independent physicians, made our proprietary technology platform seamlessly available to more than 2,500 providers during the first two weeks of the outbreak. Total virtual visit volumes increased from approximately 500 a week to over 7,000 a day in the span of 2 weeks without operational disruption.

However, patients are not seeking care at typical levels, with primary care in-office visits down 50% to 90% across the nation. With the coverage of virtual or telehealth visits, the high performing groups are only attaining 50% to 60% of pre-crisis volumes. For practices that have challenges related to geography and/or patient make-up, it can be considerably worse. That backdrop will prove unsustainable putting at stake no less than the health of our patients and the long-term future of our primary care providers.

When we can safely lift the stay-at-home orders, primary care providers will return to their post as the essential frontline team to test and treat patients, and to help ensure the safety of our communities. They may find it necessary to change the physical structure and operational protocols of their practices based on lessons learned from this outbreak. Physicians  will need additional funding to pay staff, to purchase personal protective equipment and cleaning supplies, to transform the practice’s operational workflow to safely care for their patients-and then to perform diagnostic tests and offer both sick and preventative health visits in their practices. It will not go back to "normal."

I commend the Administration and legislator efforts to address the impact that this outbreak has had on our healthcare system, but we need immediate action at the state and federal levels, as well as support from the commercial insurance industry, to protect independent physicians and ultimately their patients. Dollars earmarked and dollars delivered to this cohort to date have been insufficient with some parties not participating at all. Our communities need additional help to protect patient’s access to medical care by helping preserve both the viability of current physician practices across the country and the ability to grow and transform their practices successfully in this new environment.

Care delivery is changing. As example, COVID-19 has made the case for telehealth’s arrival that will extend well beyond this crisis. Healthcare as we know it/knew it, in many ways is no longer the standard. Still, the quadruple aim of delivering high quality, cost efficient care and  improving the patient and clinical experience, remains. Towards this end and in whatever form and at whatever pace new models for health delivery evolve, let’s not cheat much-needed actions today to preserve the outsized role primary care and the independent physician will need to play when the country has course-corrected.

Shawn Morris is the CEO of Privia Health, a national physician organization focused on value-based health care.