Primary Care and COVID-19: Facts, Trends, & Opportunities

The Current State of U.S. Primary Care in the Midst of the Coronavirus Pandemic

As a result of the coronavirus pandemic, the number of visits to the nation’s 223,000 primary care offices quickly dropped between March 1 and April 15, 2020. Specifically, pediatrics decreased 62 percent, adult primary care decreased 49 percent, and obstetrics decreased 45 percent. A significant number of these visits have been replaced by tele-visits with a surprisingly high video visit adoption rate.

Additionally, according to the Primary Care & COVID-19: Week 8 Survey1 with responses from 773 clinicians nationwide, data was uncovered that offers insights into the future of primary care:

• 38 percent of primary care clinicians believe that there will be non-COVID-19 related deaths among their patients after the pandemic ends due to diverted or avoided care.
• Over 60 percent of primary care clinicians believe that some of their patients will experience unnecessary illnesses due to diverted or avoided care.
• Just under a third of primary care clinicians expect to see a dramatic increase in the prevalence of substance abuse among their patients; another quarter expect to see dramatic increases in domestic violence among their patients and 74 percent expect to see an increase in patients with mental health needs.
• 60 percent of respondents believe that policies changed to support primary care during COVID-19 will be reversed once the pandemic lessens. A quarter of respondents say that they anticipate the pandemic will result in “a broken sense of trust between the public and the medical world.”
• 35 percent of primary care clinicians believe that most independent primary care practices will be in jeopardy by the time the pandemic ends. Most believe consolidation will force their peers to join larger organizations or retire.
• Primary care continues to call for a better public health response, but is skeptical it will come. Practices are still lacking PPE (54 percent) and full testing capabilities (54 percent). A full two-thirds say that the country will be opened too early, increasing the harms of the predicted second wave of COVID-19.
• 49 percent of clinicians report that over half of their visits were reimbursable (compared with 34 percent in week 7 and 43 percent in week 6). Still, 70 percent of respondents say they continue to see their patient volume down by more than half compared to before the pandemic.

It is clear survival is the immediate focus for primary care physicians. For example, they have had to make major changes in how they manage operations:

• Most primary care practices are cutting their operating costs by furloughing staff until patient visits are recaptured.
• Some primary care practices (9 percent of survey respondents) are extending their office hours.
• As markets begin to open primary care practices are leveraging technology to accommodate pent up demand:
  • 77 percent do tele-visits
  • 61 percent offer secure messaging for patients
  • 44 percent use an electronic medical record system
  • 25 percent offer apps for patient monitoring
  • 10 percent offer e-mail consults

Moreover, all primary care practices are:

• Integrating enhanced infection controls in their offices and actively pursuing optimal patient experience scores so preferred payers include them as ‘in-network’ providers
• Engaging with their peers to see how employment relationships with hospitals, insurers or private-equity-backed groups compare
• Looking for better ways to treat sicker, more complicated patients
• Hoping a vaccine for the coronavirus is in place later this year
• Addressing the fears and anxieties of their patients and communities

ERDMAN Takeaway

The COVID-19 pandemic propelled hospitals to the forefront of coronavirus preparedness, testing, and treatment. While emergency rooms and ICUs have been the focus, less attention has been given to the primary care network of offered practices, clinics and programs, as well as the role they play in coronavirus testing and patient care.

While hospitals will be responsible for managing coronavirus populations in the communities where they operate, primary care is the community’s front door for testing and for vaccinations when they become available.

Therefore, we strongly encourage that primary care practices consider two immediate actions:

1. PERFORM A READINESS ASSESSMENT: Assess the preparedness of your facility to ensure patient safety and the management of COVID-19 risks. This could include identifying: isolation areas for infected patients, adequate supplies and PPE for testing, standing orders relative to medication management, discharge planning, and follow-up. It is also important to have an increased focus on infection controls, workforce safety, as well as waste and biohazard disposal procedures.
2. DETERMINE YOUR FINANCIAL VIABILITY: The CARES Act provides loans/grants that could be used to address primary care needs (i.e. staffing, as well as facility and service issues directly linked to the negative impact of COVID-19 on a hospital’s finances).
   Health systems should consider assisting practices in conducting readiness assessments and securing funds. They can also complete applications and attestations, plus monitor compliance with repayment and performance requirements.

If you need any guidance in navigating this uncharted territory, we can help! For additional insights about COVID-19 and providing responsive primary care, contact ERDMAN. We are committed to helping build healthier communities, especially during these unprecedented times.