The coronavirus has rattled primary care clinics across the nation as doctors are forced to brave an unprecedented public health crisis amid losses of staff and revenue.
A recent nationwide survey by the Primary Care Collaborative showed that more than half of responding clinicians reported feeling unprepared for the next wave of the pandemic. But one expert argues challenges faced by clinicians could be the impetus for much needed change in the industry.
“I think you’re going to see less episodic care and more comprehensive care. You’re going to see more attentiveness to what the demands are of the community. You’re going to see more awareness and consumerism,” said Britt Berrett, director of the Center for Healthcare Leadership and Management at The University of Texas at Dallas.
The primary care system was fragmented prior to the coronavirus, Berrett said. Advances in medicine that called for more sophisticated technology drove many doctors to collapse into established health care systems, while others chose to remain independent.
Financial devastation sustained during the pandemic will likely put the final nail in that coffin, Berrett said. According to the Texas Medical Association, 60% of physicians at a recent town hall said revenue at their practice was down by half or more.
“The days of the solo practitioner really have gone,” he said. “Everyone is integrating, and you’re seeing that all across the United States.”
The loss of mom-and-pop clinics may seem grim, but Berrett said he believes integration is essential to value-based care. Services become more efficient and less costly when patients can get everything they need in one place, he said.
The pandemic has also spotlighted problems with the way doctors are paid, Berrett said. Primary care has traditionally operated on a fee-per-service model, meaning physicians are reimbursed based on the number of patients they see.
But shelter-in-place orders that have kept patients out of doctors' offices have undermined the sustainability of that system. According to a recent survey by the Primary Care Collaborative, about 20% of respondents said their practice was forced to temporarily close due to a lack of funds.
This will likely lead to more doctors being paid on a guaranteed schedule, Berrett said. The concept of predictable payments is popular among physicians, with 30% in support of the practice, the same survey from the collaborative showed.
“In the new environment, a primary care physician will get a monthly amount to treat and take care of you, and if he or she is efficient in that care so that you don’t have to go to the hospital, he or she participates in gain sharing,” he said.
Guaranteed payments will also allow doctors to focus on quality over quantity. Rather than trying to shuffle through as many patients as possible, doctors will have the bandwidth to prioritize comprehensive, preventative care.
“Compensation has to be focused on treatment over a long term, not episodic ... so you’re going to see us move from medical care to health care,” he said.
This will be essential as health care providers turn their focus away from treating the acute condition of COVID-19 and back to the management of chronic conditions, such as diabetes, Berrett said.
According to the collaborative, preventative care is largely not happening. Survey results from May 15-18 show only 5% of doctors reporting the continuation of cancer screenings and only 15% reporting the administering of routine childhood vaccinations.
“Individuals have not been able to get to the primary care physicians or their doctors because of the pandemic,” he said. “They have postponed treatment and care, even diagnosis, and there is a very large concern about it.”
A restructuring of the reimbursement model will also motivate more doctors to go into primary care rather than pursue more specialized areas of medicine, Berrett said.
“The compensation model into the future will benefit primary care,” he said. “That is absolutely, unequivocally the trajectory that we are seeing.”
Another service positioned to explode as a result of the pandemic is telehealth. In a poll conducted during the Texas Medical Association’s town hall, nearly 75% of doctors said they began using telemedicine for the first time only after March 1.
The forced shift to telehealth has been difficult on providers, but ultimately it should serve to heighten a doctor’s ability to provide convenience care for patients, Berrett said.
“All of us agree that [telemedicine] ... will provide greater value for primary care,” he said.
Public health is now more important than ever, and patients will begin to demand improved access to care, Berrett said. Post-coronavirus, success for a doctor will be rooted in his or her ability to cater to the patient.
“You can get into an Applebee's faster than you can get into a primary care physician’s [office],” he said. “Now, those days are gone.”