Unintended Consequences: COVID Impact on Primary Care

As the impact of COVID has been felt in all sectors of the economy, there have been some very unique consequences in the primary practice healthcare field. The preventative measures implemented to combat COVID have been hailed as very effective and overall lifesaving in the fight to help stop the spread of the virus. Wearing masks, washing hands, social distancing, and avoiding large crowds have all helped to play a part in this very challenging season. While these interventions were specifically targeted at COVID, there have been notable decreases in other infection rates and associated clinic visits and hospitalizations. These outcomes, while immeasurably positive on society as a whole, have triggered some unintended consequences in the realm of healthcare.

Consequences

While most people would think that healthcare clinics would be one of the few business organizations that would actually thrive during a pandemic, there were consequences of the crisis that caused some segments of the healthcare industry, such as primary healthcare clinics, to end up in financial distress and or complete bankruptcy. Whereas the interventions mentioned above did help to slow the spread of the COVID virus, they also had the unintended consequence of keeping patients from going to their primary care health visits for chronic disease management, acute interventions, and basic preventative health visits. These missed healthcare appointments may sound insignificant, but they are proving to have caused a disruption in the primary care market the likes that have rarely been seen.

Costs

The data is just starting to be quantified, but Harvard medical school in conjunction with the American Board of Family Medicine have estimated over a $15 billion dollar loss in revenue among primary care clinics nationwide. Other ongoing studies confirm this substantial loss in revenues, reporting estimates of over a 60% reduction in medical office visits correlating with a 54% overall reduction in revenue per healthcare provider. For social distancing, medical practices were forced to reduce their waiting room capacity and completely revamp how they triaged patients in order to prevent spreading the virus.

These changes, coupled with patient’s canceling their appointments, significantly reduced the outpatient clinic volumes around the country. Some practices went virtual, by offering telemedicine visits, which helped to keep them afloat. Revenues were still impaired, though, with the loss of volume and ancillary testing such as rapid lab tests, imaging, and other office-based procedures including vaccinations.

Economic Impact

As to the overall economic impact, the Bureau of Labor Statistics posted that 800,000 jobs have been lost in the healthcare sector during the first six months of the pandemic. The concern in the primary care market is that many of the jobs lost will not return. Half of the primary care clinics in the nation are small businesses with a fee for service revenue stream. The practices have not only lost revenue, but their overhead costs have increased significantly with the added burden of more intense office cleaning measures and having to provide staff with personal protective equipment (PPE). These practices have limited capital reserves just like most of the small businesses that have failed during this last year.

With practice bank loans to pay and the added weight of medical school loans, many community-based physicians turned to crowdfunding in order to avoid filing bankruptcy. Some rural primary care practices had Facebook posts for GoFundMe campaigns to try to keep their doors open during the height of the COVID lockdowns. One patient in Dallas even set up a GoFundMe campaign for her own family physician and raised approx. $100,000 to help her physician keep the practice going.

To help counter the effects on pediatric practices, which were among the hardest hit primary care practices, the American Academy of Pediatrics launched a campaign #CallYourPediatrician. Utilizing social media, Public Service Announcements, text messages, blogs, and other digital media, the program targeted parents with reminders about well-child exams and the importance of maintaining vaccinations for children.

Outcome

So, what is one of the most remarkable unintended consequences of this disruption in the primary care sector? While it has added to the financial losses mentioned above, it actually turns out to be a positive outcome for patients in all of this chaos. Cases of Strep infections, flu, respiratory tract infections, and other communicable ailments have drastically declined across the country. One major indicator that the CDC follows is the hospitalization rate due to flu-associated complications. For the current flu season, the CDC recently reported that only 165 patients have been hospitalized for flu as compared to several hundred thousand hospitalizations for the same period during a normal flu season. While more research into these findings is needed, the anecdotal reasons suggest that the increased handwashing, wearing of masks, and social distancing interventions in place for COVID have had a significant impact on these common seasonal illnesses.

Optimism

In my glass-half-full optimism, history reveals that we are resilient, and we will recover from this pandemic. No doubt there will be changes. In regards to healthcare, specifically primary care, I predict a “new normal” will appear. What we learned in how to treat patients during a crisis like this will hopefully make the practices of tomorrow stronger, better able to keep their doors open, while calmly educating and providing the best care possible. New delivery models and technologies will come out of this season that will help primary care to become more accessible, better equipped, and ready to face what comes next, even the unintended consequences!

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David W Clark, MPA, CPA
Instructor of Accounting & Healthcare Management
West Texas A&M University