Full-time primary care doctors in the United States will lose on average of more than $65,000 in revenue this year as a result of the cancellation of most outpatient visits from February to May, according to a Harvard Medical School study of the impact of COVID-19 on these medical practices.
The lost revenue, combined with uncertainty over how much longer insurers will cover the telephone and video appointments that are replacing many office visits, threatens the viability of some practices and could even lead to closings, the study says.
That could imperil America’s health, said the article published Thursday in the journal Health Affairs. The nation’s roughly 220,000 primary care physicians treat more than 60 percent of patients who visit doctors because of chronic conditions, including high blood pressure, diabetes, and obesity.
“A health care system without the necessary primary care infrastructure therefore is likely to be increasingly fragmented, more costly, and less effective, and these costs will be borne by all Americans,” said the study, led by researchers at the medical school’s Blavatnik Institute.
Dr. Bruce Landon, senior author of the study, said he supports the growing calls for the federal government to provide targeted relief to primary care doctors. The study estimates that it would take about $15 billion to make them whole.
“If we fail to pay attention to them, many of them are at risk for going away,” said Landon, a professor of health care policy and medicine at Harvard and a practicing internist at Beth Israel Deaconess Medical Center.
The federal government has provided financial aid to other health care sectors, including $10 billion for rural hospitals.
The pandemic caused hospitals to cancel elective medical procedures and outpatient programs so doctors could focus on COVID-19 patients. That had a devastating impact on the bottom lines of many hospitals and health systems, and the fallout has been widely reported.
Last week, Mass General Brigham, the state’s largest network of hospitals and doctors, said it would temporarily cut executive compensation and freeze pay for thousands of employees after losing $800 million in revenue during the coronavirus epidemic. The measures, which will affect 50,000 employees, are expected to save $500 million for the 12 months beginning July 1.
The health care network (formerly Partners HealthCare) also said it would suspend contributions to retirement plans. Mass. General Brigham is the state’s largest private employer, with 78,000 workers
In contrast, said the Harvard study, the plight of primary care doctors and, in particular, independent community-based practitioners, has been “lost in the din.” Primary care practitioners see patients in over half of the roughly 1 billion office visits in the United States each year.
Some of these doctors lack a financial cushion to handle the lost revenue. The average primary care practice supports four employees — clinical and office workers ― at a cost of well over $200,000 a year, according to the study.
More than a quarter of practicing primary care doctors are 60 or older, the researchers said, and the pandemic could prompt some to retire sooner than they had planned.
Many primary care doctors struggled to convert to telemedicine, even though public and private insurers generally agreed to cover it. A survey of physicians in 48 states, Puerto Rico, and the Virgin Islands in late March found that 87 percent of respondents had limited in-person visits, and 60 percent were unable to provide video visits.
The decision by the Centers for Medicare & Medicaid Services and private insurers to cover telemedicine appointments retroactively to March at the same rate as for office visits kept a number of primary care doctors from hemorrhaging more money, said Landon, the study’s senior author.
But the government has pledged to do that only for the duration of the public health crisis. Landon doesn’t know when that commitment will end, and he worries that a quarter of primary care patients will want to continue virtual visits for some time because of the fear of catching COVID-19.
Jonathan Saltzman can be reached at firstname.lastname@example.org