Primary Care Practices Endangered from Steep Declines in Revenue and Staff, New Survey Shows

The Primary Care Collaborative (PCC), in partnership with The Larry A. Green Center, today released results of a real-time survey of primary care clinicians conducted April 10-13, measuring the impact of COVID-19 on their practices. 
   
This is the fifth consecutive week the Green Center has conducted the survey, which shows that primary care practices are at serious risk of shuttering. Close to half of the survey’s respondents are unsure they will have enough cash to keep their practices open. 42% report concerns about layoffs and furloughed staff, and an overwhelming majority (85%) have seen dramatic decreases in patient volume.

The survey also found that 20% of primary care practices predict they will close within four weeks, testing continues to be limited, and personal protective equipment is hard to find. The survey also shows disproportionate COVID-19-related health burdens among specific groups, including low-income workers and racial minorities and those with pre-existing co-morbidities or mental health concerns. 

“Opening up the country and getting the economy going again will be difficult or impossible if there is not enough testing and PPE and many primary care practices are closed for business,” said Rebecca Etz, PhD, Co-Director of The Larry A. Green Center and Associate Professor of Family Medicine and Population Health at Virginia Commonwealth University. “We’re seeing so much economic pain among patients and practices. When primary care is endangered, patients and the whole health system are endangered.” 

“Congress must take rapid and decisive action with the fourth stimulus bill to make sure that the U.S.’s primary care practices remain viable, including investing in a Medicare and Medicaid per patient monthly payment for the balance of 2020,“ said Ann Greiner, President and CEO of the Primary Care Collaborative. “Independent, rural and safety-net clinicians taking care of the country’s most vulnerable patients must be prioritized." 

This week’s survey results reflect input from over 2,600 primary care physicians, nurse practitioners, and PAs. Responses covered all 50 states. Respondents’ specialties range among family medicine (69%), pediatrics (5%), internal medicine (12%), geriatrics (7%), urgent care (3%) and other (4%). Practice settings include 70% larger than 3 clinicians, 33% rural, and 28% community health centers. One-third have more than 50% of patients on Medicaid; 14% own their practice; 13% are part of academic centers. 21% is majority fee-for-service practices; 12% majority capitated; 20% had no capitation. 

 Topline analyses include:  

• Financial strain on primary care practices is impacting their ability to keep staff employed and doors open. 42% of respondents report the “need to layoff or furlough practice members” as a stress on their practice. Fewer than half of respondents feel they had enough patient volume to stay open for the next four weeks (46%) or enough cash on-hand to stay open for the next four weeks (47%).
• COVID-19 is taking a personal toll on both patients and health care professionals. Two-thirds of respondents report “rising family and economic concerns among patients” as a stress on their practice; 60% report similar family and income concerns among practice members.
• External financial support is increasing, but may be slow to arrive. Just under a fifth of respondents say that their practice is likely to apply for a Small Business Administration loan in the next four weeks. And the majority of respondents are uncertain that they will receive payments for virtual care: “likely to receive payment for video and e-based care?” No: 10%; 43%: Unsure; “likely to receive payment for your telephone-based care?” No: 16%; 44%: Unsure.
• Patients are affected differently by COVID-19 based on their age, income, and race/ethnicity. 12% of surveyed clinicians see disparities among racial minorities; 27% among low income patients; 20% among those lacking computer/internet access; 29% among those with mental health conditions; and 33% among the elderly.

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