Independent physicians are hoping for expedited federal aid as elective procedures and non-urgent, in-person doctors' visits are postponed to accommodate more COVID-19 cases, threatening their practices' viability.
Many private-practice physician groups, which are owned by doctors rather than by a health system or other entity, have seen in-person visits drop 40% to 60% over the past several weeks, similar to hospitals and other providers. That decline is only partially offset by virtual visits, and practices that do not have telehealth capabilities are particularly vulnerable, physician group executives said.
"We are fortunate to have recently invested in virtual capabilities," said Shawn Morris, CEO of Privia Health, a national physician group that is affiliated with 2,200 independent physicians. "But for clinics that have no virtual capability whatsoever that have seen volume go down 40%, 50%, 60%, you are in a negative cash flow position really quick."
Three weeks ago, Privia logged about 500 virtual consultations a week. That is up to about 6,000 a day, said Mark Foulke, executive vice president of transformational value-based care at Privia. About 40% of its visits are now via telehealth, he said.
"But we believe that is far from the ceiling. If the relief wasn't provided for virtual visits, you could imagine the impact," said Foulke, adding that while the regulatory easing has been a vital shot in the arm, overall visits are still down. "Telehealth is an access point for patients, but it is not a cure-all."
While the suspension of the Medicare sequester, the expansion of telehealth reimbursement and relaxed requirements for virtual visits have provided an immediate shot in the arm for physician groups, deploying funding through various programs and agencies via the COVID-19 stimulus bill will take some time.
The American Medical Association, which represent physician groups, urged the Trump administration to expedite the process.
"Physician practices are being hard-hit by the pandemic, which is threatening the sustainability of practices and could reduce access to care," Dr. Patrice Harris, AMA president, said in prepared remarks.
President Donald Trump signed Congress' $2 trillion COVID-19 economic stimulus bill Friday. It includes $100 billion to reimburse providers for COVID-19 related expenses and lost revenue.
The bill also suspends the Medicare sequester to boost provider payments, which was a top priority for hospital and physician groups. The sequester, enacted in the Budget Control Act of 2011 that trigged 2% mandated cuts to Medicare starting in 2013, would be suspended from May 1 to December 31, 2020, although another year would be tacked on to its prior expiration date.
Sequestration dents rural hospital revenues by an average of nearly $380 million a year, according to an analysis by the Chartis Center for Rural Health.
Congress set aside funding for medical supplies—$16 billion for the Strategic National Stockpile and $1 billion for purchases under the Defense Production Act, which aims to stimulate domestic production of supplies like masks that have been running low. The legislation also increased physician fee schedule payments in areas where labor costs are lower than the national average and boosted reimbursement for COVID-19 related treatment, among other provisions.
"Any way to get cash flow to the independent doctor is a positive," Morris said. "We are seeing an unprecedented response from CMS. We can't thank them enough."
Meanwhile, the AMA offered several recommendations to keep private-practice physicians afloat. They should implement a process for rapid decisionmaking and planning, understand their insurance coverage, make a financial contingency plan, use digital health tools and consolidate administrative resources like coding software, the association said. The AMA provided a letter template to designate employees as essential to the COVID-19 response.
The AMA offered guidance on developing policies to triage non-urgent patient requests involving protective equipment, staffing levels, staff and patient safety, and appropriately utilizing hospital capacity. The association also updated its telemedicine guide with current CPT codes and implementation tips.
"The AMA is laser-focused on ensuring the viability of physicians' practices that are being impacted by the pandemic and will continue providing tools and resources and aggressively advocating on their behalf," Harris said in prepared remarks.
The number physician groups owned by doctors has been steadily declining. Only 47.1% of physicians in 2016 had ownership stakes in a medical practice, according to AMA data.
While it hasn't been enough to reverse the trend, some small groups of doctors are leaving their hospital employers for independent organizations.
Also, many private-equity firms have been buying and rolling up specialty groups across the country. Although, that model looks less certain now, Morris said.
"They have put doctors on salaries, but those volumes have really dropped off," he said. "As cash flow slows to a halt, that model doesn't look as good to investors."
