Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

The economics of primary care in a COVID-19 world

Ameer Ali Khowaja, MD
Physician
June 8, 2020
50 Shares
Share
Tweet
Share

Much has been written about the response of the governmental agencies in the foreseeability of COVID-19 spread and management in the United States. Travel restriction from mainland China seemed to be a very timely intervention. However, instead of considering it as an initial step in a prolonged exercise of vigilance in preventing the disease from getting a foothold on the continent, it was considered the only one. Now it is well documented that majority index cases came from Europe.

Regardless, SARS-CoV-2 is here now, and states will follow a peak, trough, and likely multiple cycles of such in varying timelines. So what is the way forward? As states try to ease the economic pains of their residents, the incidence of new cases, hospitalizations, and mortality will depend upon many factors. These include population density, higher-risk groups, health literacy, political ideologies, state health care, and economic resources.

That, in turn, will determine the communities’ compliance towards maintaining the practice of social distancing, universal masking, and other strategies as we learn more about the pathogen.

Health care comprises 20 percent of the U.S. GDP. Therefore like other parts of the economy, health care has sustained a significant economic toll. However, a paradoxical phenomenon happened within health care. During these times of unprecedented economic downturn, triggered by the health care-related event, a significant part of health care infrastructure is shut down or reduced to crawling pace in terms of services and economic activity while the rest of the system, including E.R.s, inpatients and ICUs are on overdrive mode.

An ongoing survey by Primary Care Collaborative — a non-profit initiative showed that 49 percent of primary care practices report severe impact on their practices. Ninety percent of practices had to eliminate chronic care appointments (due to lack of personal protective equipment, among other things), and 82 percent of practices have not had any or limited testing capacity for SARS-CoV-2.

News of layoffs and furloughs are flooding the media. Health care providers from small outpatient practices to the mega health system are being forced to take a reduction in compensation. Latter is baffling since one of the reasons for their existence is the supposed financial sustainability and cushion in the face of such calamity.

The economic impact of this pandemic on health care will likely be in three phases.

1. Acute loss of revenue from the inability to provide services in both COVID (due to lack of testing capacity, among other things) and non-COVID settings, including elective procedures/surgeries, primary care, and other specialty services. Patients are being advised to either stay at home or seek care in E.R. for non-COVID related conditions.

2. As the unemployment rate will continue to grow, many patients will lose their health insurance. Hence, they likely will try to avoid seeking health care as long as they possibly can, which usually leads to worsening of conditions and outcomes both clinically and financially.

3. As states reopen their economies and patients rejoin the labor force, there is a significant lag between initiation of employment and reinstatement of health benefits (if at all offered by the employer in the first place). That will contribute to inertia in the economic recovery of health care, even when other parts of the economy will be getting up and running.

As with #1, many practices may qualify for relief under CARES Act. However, as for #2 and #3, there is no objective way to determine the depth and duration of the impact.

Among many things, this pandemic should make us realize that the health care system and its delivery in this country are too complex to navigate and too rigid to adapt to rapidly changing circumstances. As Julie Yoo wrote, “primary care was meant to be the front door to the health care system … to help us navigate the rest of the convoluted care delivery ecosystem. But as a front door, it’s pretty broken.”

According to the CDC, out of 883.7 million visits in 2016, 54.5 percent were to primary care providers. According to the Kaiser Family Foundation, 48 percent of practicing physicians are in primary care. Therefore any interventions to keep primary care practices on their footing will help mitigate the economic fallout and likely better clinical outcomes related to the current crisis.

At the same time, primary care in the U.S. is under-invested and undervalued. Primary care physicians are under-compensated and overworked (much so with non-clinical work). Nevertheless, considering the volume of patients these practices attend, it would be unwise not to utilize them in this ongoing pandemic.

As states’ economies plan to reopen, there should be the concern for not only a “second-wave” but multiple waves (hopefully each of lower magnitude) in the foreseeable future. Primary care infrastructure should be heavily invested in and utilized as the front line for the diagnosis, mass public education, contacts tracing as a matter of public health policy because these practices are usually situated within the communities impacted. Moreover, they usually have long standing relationships with their patients, their families, and, by extension, to those communities.

During the first wave, it is apparent that the primary care practices were completely overlooked as high-efficiency resources for the containment and mitigation process as they struggled and continued to do so to obtain guidance, protocols, and logistical resources. As we head to the next phase(s), technological tools offered by tech giants like Apple and Google and programs like Peace Corps and AmeriCorps will be valuable. However, primary care practices can play a paramount role in integrating these technologies and human resources to the communities and can potentially improve communities’ compliance significantly.

This pandemic provides a crucial window of opportunity to the movers and shakers of the U.S. health care system to provide much-needed support to the primary care infrastructure. So they can perform critical work on diagnostic tests, manage non-critical COVID-19 cases, and educate the communities they practice in. It will allow not only for an effective containment and mitigation strategy for SARS-CoV-2 but also provide economic support to hundreds of thousands of jobs in health care.

Ameer Ali Khowaja is an endocrinologist.

Image credit: Shutterstock.com

Prev

During the pandemic, faith keeps us together [PODCAST]

June 7, 2020 Kevin 0
…
Next

Listen a little closer. Understand a little deeper. Heal a bit better.

June 8, 2020 Kevin 0
…

Tagged as: COVID, Infectious Disease, Primary Care

Post navigation

< Previous Post
During the pandemic, faith keeps us together [PODCAST]
Next Post >
Listen a little closer. Understand a little deeper. Heal a bit better.

Related Posts

  • COVID-19 proved that diverse voices make health care better

    Naprisha Taylor
  • Primary Care First: CMS develops a value-based primary care program for independent practices

    Robert Colton, MD
  • The COVID-19 pandemic is a catalyst for reimagining future health care delivery

    Imelda Dacones, MD
  • COVID-19 adds a new health care gap: internet disparity

    Sandra Swantek, MD and Magdalena Bednarczyk, MD
  • Health care delivery after COVID-19: Move more procedures to the outpatient setting

    Shikha Jain, MD and Krishna Jain, MD
  • Reflecting on my experience as a teenage health care worker during the COVID-19 pandemic

    Ananya Raghavan

More in Physician

  • Heartwarming stories of cancer patients teaching us about life and the human spirit

    Johnathan Yao, MD, MPH
  • We need a new Hippocratic Oath that puts patient autonomy first

    Jeffrey A. Singer, MD
  • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

    Ton La, Jr., MD, JD
  • How can there be joy in medicine if there is no joy in Mudville?

    Arthur Lazarus, MD, MBA
  • Physician entrepreneurs offer hope for burned out doctors

    Cindy Rubin, MD
  • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

    Elizabeth Cerceo, MD
  • Most Popular

  • Past Week

    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician
    • From skydiving to saving lives: a surgeon’s journey on adversity, passion, and perseverance [PODCAST]

      The Podcast by KevinMD | Podcast
    • How can there be joy in medicine if there is no joy in Mudville?

      Arthur Lazarus, MD, MBA | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Hypertension Tied to Worse Survival After Surgery for Upper Tract Urothelial Cancers
  • Supply Chain Problem for Primary Care
  • The Role of Amyloid PET in the Management of Alzheimer's Disease
  • New Inflammation Inhibitor Proves Effective and Safe for Dry Eye Disease
  • Myocardial Infarction Tied to Faster Cognitive Decline

Meeting Coverage

  • New Model Aims to Study Intestinal Fibrosis in Crohn's Disease
  • Hypertension Tied to Worse Survival After Surgery for Upper Tract Urothelial Cancers
  • The Role of Amyloid PET in the Management of Alzheimer's Disease
  • New Inflammation Inhibitor Proves Effective and Safe for Dry Eye Disease
  • No Access to Routine Healthcare Biggest Barrier to HPV Vaccination
  • Most Popular

  • Past Week

    • How chronic illness and disability are portrayed in media and the importance of daily choices for improved quality of life

      Juliet Morgan and Meghan Jobson | Physician
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • A patient’s perspective on the diminishing relationship between doctors and patients

      Michele Luckenbaugh | Conditions
    • Emulating Michael Jordan’s winning mindset: a path to success for health care professionals and entrepreneurs

      Harvey Castro, MD, MBA | Physician
  • Past 6 Months

    • The growing threat to transgender health care: implications for patients, providers, and trainees

      Carson Hartlage | Policy
    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
  • Recent Posts

    • A family physician’s journey on the OIG list and the struggle to return to practice [PODCAST]

      The Podcast by KevinMD | Podcast
    • Heartwarming stories of cancer patients teaching us about life and the human spirit

      Johnathan Yao, MD, MPH | Physician
    • We need a new Hippocratic Oath that puts patient autonomy first

      Jeffrey A. Singer, MD | Physician
    • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

      Ton La, Jr., MD, JD | Physician
    • From skydiving to saving lives: a surgeon’s journey on adversity, passion, and perseverance [PODCAST]

      The Podcast by KevinMD | Podcast
    • How can there be joy in medicine if there is no joy in Mudville?

      Arthur Lazarus, MD, MBA | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...