Q&A: Involving local practices in COVID-19 vaccinations

Anders Gilberg, senior vice president of government affairs for MGMA, discusses a recent survey and how his organization is reaching out to the White House.

A recent vaccine rollout survey by the Medical Group Management Association (MGMA) paints a vivid picture of how physician practices are being left behind in the push.

Medical Economics sat down Feb. 1 to discuss the survey with Anders Gilberg, senior vice president of government affairs for MGMA. Below is a transcript of that discussion, which has been edited for length and content.

Medical Economics: What can you tell us about MGMA’s recent vaccine survey?

Anders Gilberg: Well, we had been getting a lot of our members, we have 15,000 medical groups across the country in our membership, and we had been hearing anecdotes from our members about their desire to vaccinate their patients. It's what they do. They already do it. They vaccinate annually for influenza and other conditions and diseases. So they have experienced doing it.

But from those anecdotes, we wanted to see if we could quantify it. So (in late-January), we did a quick poll, we got about 400 responses, but we only asked practices that were actively seeking the vaccine for their patients and not maybe some specialty practices like maybe radiology or pathology. We're just looking at a lot of multi-specialty practices and primary care and some specialties that especially focus on patients with chronic disease and have conditions that would put them in a high-risk area for COVID.

I want to say I was shocked, but I wasn't really, if I may, I can give you just kind of the top line, which is just a few questions we wanted to know: "are you able to obtain vaccine for your patients," and about 70 percent of practices reported back that they were not able to receive or obtain any vaccine for their patients.

Not surprisingly, more hospital-owned practices were able to get vaccine for their patients, and independent practices, sadly, 85% of them said that they were unable to get it for their patients.

So, why is this a problem? I mean, it's obvious in terms of the numbers. The main concern that we have is there's supply issues in the country with respect to the vaccine. But we have other very serious issues, you know, vaccines were distributed quickly to hospitals, and there's nothing wrong with hospitals, but they're not necessarily set up to be vaccination centers. They could store the Pfizer vaccine, but so could some medical practices and virtually all of the practices that responded could store, for example, the Moderna vaccine. So, at least half the vaccine that's available is stable for medical practices. So you know, right now we have such a frantic dash among patients to find vaccine, whether it's in parking lots so that the county is set up, websites that you have to just keep hitting reload on to see if any new appointments might show up at a county facility.

But our main concern is that last mile, and where medical practices can really contribute here is actually proactively identifying the most vulnerable patients and they can generate lists from their electronic medical records. They do it for value-based care initiatives now where they they know which of they're patients are over a certain age, but also with various chronic conditions that are being targeted populations that need the vaccine.

So I think you know, what we'd like to see and one of our big asks, and we wrote President Biden, is to kind of flip this process around, and to really engage medical practices in that delivery, because they can proactively identify patients, they can reach out to patients, they can bring them into the practice, they have experience, they have nurses who give shots. So, there's a lot of opportunity for community practices to play a significant role in actually getting shots in the arms of patients. I don't think we can expect that, especially the most vulnerable patients, will be the ones that are the type of patient to scour the internet for places to sign up or hear from word of mouth of an opening at a local drugstore for a few vaccines.

So, I think we can do this a lot better, and so we wanted to at least find out from our members what they are experiencing and then do what we can to help deliver the vaccine in a more proactive and rational way than what's going on now.

MedEc: Can you tell us more about the letter MGMA sent to President Biden?

AG: Well, he has reconstituted a task force to look at how to better deliver the vaccine. Obviously, there's still more vaccines coming online, hopefully, with Johnson and Johnson, we'll get some new approvals soon. But we, we simply want to establish a relationship with the new administration, prior administration, we had a relationship with them, but they didn't have an extensive plan, really, on the distribution end, and I can't say that there was a significant, clear plan. A lot of vaccine was distributed quickly to hospitals, understandably, to get at the frontline workers. But when you step beyond the frontline workers, and you think about the role of a hospital in the community, they're slammed taking care of patients with COVID. They're not set up to do vaccination clinics, or even to have people go on their website and sign up. And they just don't have the same type of reach into the community as medical practices, and some medical practices are quite large.

So, we just wanted to make sure that we're reaching out to the new administration, that we offer the opportunity to work with the administration, and to give them some ideas on how we can do this in a lot more thoughtful, proactive manner that doesn't just reward the patient that can advocate for themselves. There are a lot of patients in this country that can't advocate for themselves, but their medical practice, their physician can advocate on their behalf. And if we get these vaccines in the hands of physicians, and in their practice, we can do a lot more and do it quickly.

MedEc: What are you hearing from practices?

AG: Well, with respect to this issue, it's hopefully turning around. I'm hearing a little bit of difference. Now, some of those hospitals, for example, that received the vaccine, after they vaccinated the physicians and nurses and other frontline staff, they actually turned some of the vaccine over to practices, because they understood that medical practices in the community, primary care, and other specialties can help deliver the vaccine.

So, we're seeing some partnerships between hospitals and medical practices, and so that's heartening. I guess the one thing, I would say the dire straits that medical practices were in back in April, we don't have that situation quite as bad right now as we shift into 2021. A lot of those federal programs that help stabilize medical practices were significant, and they helped a lot. We have some that are applying for the second round relief monies and opportunities to take loans out to help bolster reserves of their practice and make sure that they keep their staff on board and payrolls up and running. But in 2021, they're starting to focus more on the aftermath; there's a lot of red tape and reporting that's going to be required of medical practices to justify the monies they did receive in 2020.

So, we're at least, from the executives that I'm speaking to, outside of this frustrating situation with the vaccine and their inability to obtain it to really help their patients. They're focused on that next phase of reporting of not just the tax decisions they made at the end of 2020, but now how do we report and to make sure that, for example, if they got the PPP loan that they could get some of that money relieved, so they don't have to pay it back or with the provider relief fund that was distributed by CMS to make sure that they're allocating the money appropriately so they don't have to give it back. So, I think they're doing okay, but I think they want to do more and so that that's a good thing that that they want to be engaged with this phase of the of the pandemic and really get involved in the vaccine rollout.

MedEc: Are lawmakers looking at ways to improve the vaccine rollout?

There is openness, for sure. There are some hearings this week in Congress about the vaccine rollout. Again, not sure there's a lot of different parts of the rollout that need to be the focus, and I think we're where our members can really take a leadership role and make a difference in that last mile and being proactive in their communities. So, we're trying to highlight what we can do to help and offer up our help where that is relevant.

I was reading about, we don't represent pharmacies or community pharmacies, but I was reading about some of the success that West Virginia had at getting their population vaccinated. They attributed a lot of that is engaging the community pharmacies and I think that's great. So, it just seems when I'm speaking to a lot of our medical practices, they're mystified why there isn't more community focus and getting the vaccine out. Tt seems to have worked in West Virginia.

So just think about if you had the community pharmacies, and the local medical practices really reaching out into the community. We can do a lot here to turn this around, and so that's the message we're taking to, whether it was our letter to President Biden, or to members of Congress that are open to ideas and are hearing from their constituents that they're on long lists, and they don't know when they're going to get it. Some of them are 75 years old, and it's all it's very dependent on what state they're in. Each state is a little different. But I think we can do some things to turn this around, and our members are eager to do that.

MedEc: Is the issue more local or federal?

AG: Well, you're trying to do many things in health care. It is very local in nature the way it's delivered. The economics of health care is different around the country, the populations are different around the country, so it's important that the federal government doesn't try to apply a one size fits all approach. However, the observation that we would make is that there was a strong desire by the federal government to push the vaccine down as quickly as possible to the states. And then also, the state's then getting it out into the communities, but that that's why it ended up more in the hospitals or the government side of the distribution process.

In some places it's working better than others. Some local health departments have some capacity to do this and had some experience, some have none, some have been hurt by COVID in terms of their staffing and are struggling, so their infrastructure isn't there to vaccinate. Many of them have been under underfunded and those community health departments, they're just not set up to do this.

Instead of this, our recommendation would be to those county health departments, instead of signing up individual patients to get vaccinated, it's a lot easier to sign up medical practices to help with that very process. I kind of am left scratching my head sometimes when I'm reading the paper, and it says that we have a shortage of clinicians and trained nurses and doctors to literally give shots to people. That completely misses the fact. One example is that they want physicians who are retired to come out of retirement to deliver shots. Yeah, we have physicians, nurses, you know, lab techs, and a whole army of clinical staff that is actually in medical practices right now and can do it.

So, maybe we should look to those that do it every day as opposed to pulling people out of retirement and think about how to leverage what works in a community.Health care is local, and who better to know that than the community providers, whether they be medical practices, physicians, or community drugstores. So many of the ideas that are more of a top-down idea involve, like, let's get the big chain drugstores involved get Amazon involved. Those are not approaching that really take into account the unique needs of a community and their specific population.

So I guess I wouldn't say if there’s one person to blame for all of this, but now that we've kind of had the experience, I think we definitely need to learn from our experience. In many communities, it's just not working to get people signed up. It shouldn't be that we vaccinate the squeakiest wheel, we need to get out in the community. For example, with long term care facilities, we went into the facilities to deliver shots to those vulnerable patients, and medical practices can help the same way. Just because someone is over 70 but living at home doesn't mean that they don't have the same needs to be protected by the COVID vaccine. We believe physicians and medical practices can really help with that.

MedEc: IS there anything else you’d like to add?

AG: Again, we just want to get our message out there. We're not trying to get vaccine for ourselves, we're trying to get vaccines for our patients. You know, it's disheartening when the phone rings every day in a medical practice, and patients are decidedly upset and angry that their doctor can't help them in this time. And there's a lot of opportunity to get beyond that, and to really get the vaccine out in the community.

I will add that trust is a big factor and a lot of physicians can help their patients understand and deal with some of the concerns that those patients may have about the vaccine. So, there's such a role to play. Patients have concerns about the speed with which this vaccine was produced, the efficacy of the vaccine, the safety of the vaccine, and that trusted role of physician-patient relationship, and that patients have in their communities mean that that is a significant role that we should really seriously think about because especially in underserved communities, there's a lot of vaccine hesitancy. So, I think there are countless opportunities to really help and you know, medical practices and physician practices are standing by and hopefully they'll get vaccine, and they'll be able to get out and get shots in arms. I think we can really contribute here.