It may seem counterintuitive, but medical practices have been among the businesses that have sustained the most significant economic losses due to the Coronavirus crisis. And it appears that the damage may continue for many more months, particularly for primary care providers.

One would assume that a devastating national health crisis like a pandemic would send people to their doctors’ offices in droves. In fact, the opposite has been true. Fearful of potential exposure to the virus, individuals are embracing telemedicine to address emergent or acute health issues that would have resulted in an office visit under normal circumstances. More significantly, they are delaying check-ups and preventive care visits designed to keep them healthy.

It is important to keep in mind that preventive care has been the focus of payment reform that has swept the healthcare industry over the past several years. Many primary care providers – internists, family practitioners and pediatricians – participate in risk-sharing Value-Based Payment (VBP) and Quality Incentive Programs (QIP) promulgated by the Centers for Medicare and Medicaid Services (CMS) through private insurance companies participating in Medicaid Managed Care.

The basic premise of these programs is that physicians who meet certain benchmarks for delivering preventive services to their patients receive enhanced payments. So, for example, a provider who can document that 90% of her eligible patients received the recommended vaccines within a certain reporting period may earn additional dollars for the timeframe in which the benchmark was met. More recent iterations of the program include penalties resulting in lower payments for those who fail to meet the standard.

Here is how COVID-19 impacts on these doctors: with far fewer patients coming to the office for annual physicals and preventive care, the onus is on them to meet benchmarks in a compressed time frame. For most, this goal will be impossible to achieve.

But there’s more. New York State’s Department of Health has announced a 50% cut to the program that funds these incentive payments. This means that doctors will have less time to compete for far fewer dollars, while still being expected to meet the full number of metrics. Imagine being asked to perform 100% of your work for 50% of your pay. The financial impact on small, independent practices could be devastating.

Independent medical practices have been in the economic crosshairs for years. Large health systems are gobbling them up, intent on creating a pipeline of patients into their facilities for more lucrative, specialized procedures. Skyrocketing malpractice premiums have forced others to give up their independent status, while some have simply thrown in the towel, overwhelmed by decreasing revenues, increasing regulation, and an ever more complex business environment.

Yet the survival of independent primary care practices is essential for the health of our communities. Many are located in economically disadvantaged areas, where health systems focused on the more profitable privately insured patients are unlikely to establish offices. They are more likely to care for Medicaid and uninsured patients, and through their participation in VBP/QIP programs, are improving these patients’ health and well-being by emphasizing immunizations, screenings and preventive care.

Our leaders in Albany are grappling with a multitude of serious effects of the COVID-19 crisis, which is impacting virtually every level of society, from healthcare to the economy, transportation, education, recreation, and more. While these issues must be addressed, it is vital that we ensure the economic viability of private primary care medicine throughout the State. Draconian funding cuts and impractical deadlines may threaten the very survival of independent medical practices. Their condition is critical. We must act to save them now.

 

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