Letters: How will history judge our response to the pandemic?

The recent commentary by Aledade CEO Dr. Farzad Mostashari, “COVID-19 pushing primary care to brink of collapse,” stated, “By all accounts, we are merely in the opening salvo of the COVID-19 outbreak in the U.S., and already our primary-care defenses are falling apart.” I can bear witness to that.

I have been in private practice in Nebraska for 17 years. I have 10 employees who rely on me for their living. Some of them are the only working member of their household now. We have had two patients test positive for COVID-19 in our practice. We are seeing a drastic decline in the number of patients we see daily because of the government recommendations and the fear that people will get the virus if they go to the doctor. It is drastically affecting our bottom line.

I have dropped my salary as low as I can to still be able to pay my bills at home, but even that isn’t enough to secure my ability to cover payroll. I did receive a stimulus deposit from the federal government that will pay my rent and utilities for a month. I have applied for a CARES Act loan, but have heard nothing. If this doesn’t end very quickly, or we don’t receive some other source of help, we will be in deep trouble within a month. It is frightening, honestly frightening.

Dr. Lorrie L. McGill
Papillion, Neb.

We are in the midst of a historic and unprecedented event. The COVID-19 pandemic of 2020 will be one for the history books. How will history judge our response to this crisis?

Certainly, we as a nation and as a health system were unprepared for a pandemic of this magnitude. It has exposed the flaws and weaknesses in our system and pointed out the real need for expanded primary care in our country. It has also been a stark reminder of the importance that social determinants of health play in an individual’s and communities’ overall health. African-Americans have been disproportionately at higher risk of contracting and even dying from COVID-19.

As I write this the week of April 13, Alabama now has over 3,800 cases of COVID-19, a doubling of cases in less than one week, with approximately 109 deaths in our state. We now have cases in all of Alabama’s 67 counties.

Like governors, mayors and other local health officials across the country, Alabama’s state health officer, Dr. Scott Harris, has been recommending self-isolation and social distancing for several weeks now. Gov. Kay Ivey issued a statewide shelter-in-place order effective April 4. For a contagious respiratory infection for which we have no treatment, isolation, social distancing and public avoidance are our only effective means to slow the spread of this disease and save lives.

The closing of schools and day-care centers, the shuttering of non-essential businesses, the avoidance of large group meetings, the delaying of elective medical procedures are all disruptive and will cause economic hardships. But it will save lives. That has to take precedence.

Stay at home, folks. The life you save may be your own, or mine, or someone you love.

Dr. John S. Meigs Jr.
President
Medical Association of the State of Alabama

The article “Medicare may lose majority of risk-bearing ACOs from shared savings program,” highlights the threat COVID-19 presents to the nations’ accountable care organizations. In the last year, successful ACOs saved the Medicare Shared Savings Program three-quarters of a billion dollars by delivering care that met the specific needs of patients.

The implementation of the “extreme and uncontrollable circumstance” policy for ACOs is a positive step. We may need additional measures to protect the viability of medical care in many hard-hit communities. However, there is another consideration that must be addressed.

ACOs incur upfront, and ongoing, infrastructure costs to successfully care for their communities with no direct reimbursement from the CMS to cover those investments. Earned shared savings is the only financial source ACOs rely on to fund those resources.

To protect against a secondary crisis, any discussions about adjusting downside risk must not include disruption of earned savings opportunities. Altering the aligned incentives of successful ACOs would cause financial pressures that may lead to more groups leaving the program—eliminating the very front-line safety net we rely on to protect the health and safety of our seniors.

Mark Foulke
Executive vice president of transformational value-based care
Privia Health