Is this the end of the independent physician?

July 13, 2020

The plight of the independent physician has never been so stark.

When we look back on this time, will we remember fondly the era when the American patient still had a trusted primary care physician? 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 front lines 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 health care industry, most acutely felt by the nation’s traditional front-liners in primary care. 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 health care. COVID-19 has changed everything. 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 a few months of COVID-19 driven business contraction.

While physicians 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.

However, patients are not seeking care at typical levels, with primary care in-office visits down 50% to 90% in the United States. 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.

As stay-at-home orders lift, primary care providers are returning 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.”

We need immediate action at the state and federal levels, as well as support from commercial payers, to protect independent physicians and their patients. Dollars earmarked and dollars delivered to this cohort to date have been insufficient. Our communities need additional help to protect patient’s access to medical care by helping preserve both the viability of current physician practices and the ability to grow and transform their practices successfully in this new environment.

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

download issueDownload Issue : Medical Economics July 2020 Edition