The impact of COVID-19 on physician practices

A monthly survey conducted throughout 2020 tracked how the pandemic affected practices.

While the COVID-19 pandemic has impacted industries across the globe, calculating the precise repercussions it has had in healthcare has been difficult.

A new report from the Medical Group Management Association (MGMA) titled “Quantifying COVID-19: Measuring the Pandemic’s Impact on Medical Practices,” seeks to give a more complete view of how COVID-19 hit practices by combining data from the MGMA 2020 Monthly Survey. The survey collected quantitative data from 142 groups and 1,252 providers from across the country and the insights of leaders still navigating the road to recovery.

“The data tells the story of a very challenging time in history and how quickly and creatively a majority of practices were able to pivot and survive,” Andrew Swanson, vice president of Industry Insights at MGMA, says in a news release. “To sustain patient care and volume, support staff working remotely, enhancing safety procedures and embracing telehealth, practice leaders and healthcare workers adapted to extraordinary levels to overcome the pandemic’s impact.”

The most wide-ranging impact of the pandemic was the steep drop in patient volumes across healthcare. By early April 2020, 97 percent of respondents had reported a drop in patient volumes. A further 71 percent of those respondent say they saw a 50 percent or more drop in patient volume at that time.

The following June volumes began to rebound with 87 percent of healthcare leaders saying they’d seen a recovery from the start of the pandemic. This recovery was more strongly seen in terms of work relative value units (wRVUs). While only 49 percent of respondents reported seeing a return of more than 75 percent of patient volume by June, wRVUs after that time were near or above reported levels for February and March 2020, according to the report.

The report postulates two possible causes for this: care deferrals early in the pandemic may have kept low-acuity care patients from seeing a physician and patients with high-acuity care needs may have gotten worse due to delayed care causing more higher wRVUs.

This tracks with other research from Harvard and healthcare technology company Phreesia which saw a 5 to 6 percent dip in cumulative patient visits below a typical year.

The drop in patient volume was tied to similar falls in compensation. Specialists, both surgical and nonsurgical, seeing the steepest decrease due to the suspension of surgeries and elective procedures in the early months of the pandemic, a loss of referrals, and affiliated hospitals being overwhelmed due to COVID-19 care. Primary care physicians saw a similar drop in the early months of the pandemic, but the expanded use of telehealth restored much of the patient volumes and compensation later in the spring, the report says.

The impact on compensation was influenced by the compensation plans used. Volume-driven plans being hit harder than risk-based arrangements with prospective, per-patient per-month payments keeping compensation levels higher.

Meanwhile, many practices already hammered by a drop in patient volumes saw their spending for cleaning supplies and personal protective equipment (PPE) increase as demand soared. In August 98 percent of healthcare leaders reported increased total costs for obtaining PPE and 15 percent reported their PPE costs increased by more than 100 percent compared to the prior year, according to the report.

Despite this increase in PPE costs, the impact was mitigated overall by spending cuts in other areas of the practice such as layoffs, furloughs, and decreasing in-person patient visits.

The stress of the pandemic also seems to have accelerated the physician market with 28 percent of healthcare leaders reporting an unexpected physician retirement in 2020. Physicians left the industry across multiple specialties, and this year will continue to a year of recruiting and hiring new doctors, the report says.

Among healthcare leaders, interviews determined the top factors in surviving the impact of the pandemic include:

  • Fast and effective response to relief/aid offerings – Furloughs and layoffs were less likely at practices that took advantage of federal emergency relief funds.
  • Stability in staffing – Despite the need to reduce hours as patient demand declined, many top-performing practices rarely suspended operations with many pivoting to telehealth.
  • Finding the right telehealth fit – Quick expansion of telehealth offerings was key to offering care during the pandemic, but finding the right mix of video visits, audio-only visits, and remote patient monitoring that fits with the practice’s goals and the patients’ needs.
  • Rethinking patient payments and collections – Job and coverage losses in the community due to pandemic shutdown and many practices implement 30- to 60-day pauses on collections at various points during the year.
  • Sustaining engagement with patients – While telehealth was a lifeline, keeping communications open with patients and giving them a sense of security.
  • Taking care of each other – Burnout was high even before the pandemic began, the added strain led successful practices to step up their focus on physician and employee wellbeing.