Primary care practices focus on the preventive care that keeps patients healthy. Many of them are small but punch above their weight in providing access to services in underserved communities.
A series of new surveys by researchers at NYU have found that the city's primary care practices have been particularly hard hit by the pandemic. Many of them worry they may not come out on the other side.
Initial survey results collected in mid-April yielded responses from nearly 500 primary care practices across the city and revealed that the COVID-19 crisis was having a severe impact on 85% of them, NYU said. The most common sources of stress included shortages of personal protective equipment, which 53% of respondents reported. Nearly half noted strain from large volumes of patient calls, and 42% reported struggles with staff illness.
For practices that remained open, more than half of patient visits were completed via video or telephone, the researchers found. However, some providers were unsure whether they would be reimbursed for them.
In the most recent iteration of surveys, completed May 21, more than 120 practices responded, and 72% said that they were detrimentally affected by the crisis. More than 60% of respondents cited decreases in revenue as a severe source of stress.
"It is frustrating because small community clinics are completely forgotten," one practice from Brooklyn responded. "We don't get funds, and insurance carriers pay peanuts for televisits—that is, if they choose to pay."
Though many primary care practices have applied for varying loan and grant programs to help ease some of the financial strain, there is concern they haven't been a priority for federal relief.
"We all understand that the crisis is at the hospital level, but what's remarkable is that in the midst of this overwhelming crisis of hospitalizations, people were forgetting there are other front line healthcare workers, and they're called primary care doctors and nurses," said Dr. Donna Shelley, professor of public health policy and management at the NYU School of Global Public Health, who is leading the research.
The Medical Society of the State of New York also noted that more federal funding is needed to support physician practices during the pandemic following its own survey. And even large practices have noted the high costs of obtaining PPE.
Shelley and her colleagues are working with NYU Langone Health as well as the city Health Department on the research.
NYC Reach, a program at the Health Department that assists primary care providers in the city, has collaborated with NYU to assess COVID-related challenges and needs. Since the pandemic began, the program has worked with small independent practices on adapting to state and federal regulations for reimbursement of virtual services, and utilizing other healthcare incentive programs.
The goal of the surveys is to gather data on the evolving needs of primary care practices and to put together actionable data that could help support them during and after the pandemic, Shelley of NYU said. Additional support could ensure that they have a greater role should another health crisis emerge.
She collectively calls the primary care practices the "silent safety net."
"If 50% shut their doors, they worry that their patients would have nowhere to go," Shelley said. One practice responded that members of its staff can speak four African languages, an essential part of providing quality care to the patients it serves.
"Primary care is the foundation of our healthcare system," Shelley said. "We have underinvested in it for decades."
"Primary care practices fear they may not survive the pandemic" originally appeared in Crain's New York Business.