COVID-19 Primary Care Challenges and Opportunities

The coronavirus has created a unique and challenging dichotomy in healthcare—some physicians in acute care settings are overwhelmed with urgent patient needs and other providers in outpatient settings are experiencing a massive decrease in volume.

Understandably, much of the public attention is on the busiest parts of healthcare, and to those frontline caregivers at hospitals, urgent care centers, and nursing homes, we simply say, thank you.

On the other hand, primary care providers are at a standstill. For PCP practices, particularly those who serve seniors, the virus presents some daunting challenges: preventive and routine care is simply not taking place, volume and revenue have plummeted, and offices are short-staffed. These factors are creating a perfect storm that is literally jeopardizing the survival of PCP practices and putting the lives of patients suffering from chronic diseases at greater risk.

Fortunately, there is a path forward. Unlike much of the doom and gloom circulating the web, we won’t just focus on the magnitude of the problems – we’ll provide a creative solution.


Declining Patient Volume

Across the country, in-person clinical visits—the foundation of primary and preventive care—have decreased at an alarming rate. In a mid-April survey, PCPs reported that their volumes had plummeted by 65%, with seniors showing the sharpest drop in visits. Office closures and decreased volume are threatening the financial viability of PCPs, especially smaller and independent practices.


Declining Practice Revenue

With the rapid decrease in patient volume, practices are now facing a severe financial strain as their revenue follows a similar trajectory. While telehealth has helped PCPs replace some in-person visits, these interactions have not led to significant, reimbursable revenue yet. Though 96% of primary care visits authorized for Medicare beneficiaries are now eligible for telehealth reimbursement, inconsistent guidelines and poor member engagement have made it challenging for providers to take full advantage of telehealth. All of this is creating a stark new reality – only one third of PCPs feel confident that their practice has enough cash to continue operating for the next month.


Declining Member Engagement

The disparity between reimbursable telehealth visits and the PCPs’ ability to take advantage of them boils down to engagement. Telehealth appointments, unfortunately, are not being adopted at the same rate that in-person is being abandoned. Additionally, many of the Medicare telehealth waivers require real-time audio and video communication, and providers are finding it difficult to identify easy-to-use platforms for seniors that also integrate into their practices’ workflows.


Practices are Short-Staffed

During this time, PCPs are facing unprecedented business and staffing decisions. Four out of 10 PCPs recently reported having to reduce their staff headcount. Many others are on rotations to keep staff healthy or are accommodating whatever situations employees may be facing in their own families. This has led to a precarious situation. The PCPs, who were already overworked pre-pandemic, are now left to do the back-office work—scheduling, follow-up, billing, technology, and more—on top of visiting with the patients they can get through the virtual doors.


Increasing Risk for Seniors

Given seniors’ increased risk of developing more serious complications from COVID-19 illness, it is especially important to keep them physically isolated. The Catch-22 is that as the months tick by without proactively managing existing chronic conditions, their long-term risks of serious illness rise significantly. Furthermore, social isolation has been linked to decreased cognitive function, depression, cardiovascular disease, and many other health risks.


The Solution: A Risk Adjustment and Quality of Care Solution at the Point of Care

For many years, PCPs were led to believe that HCC coding in support of risk adjustment was best left to home assessment or other vendors not connected to the treating provider. Despite the many shortcomings of this approach—patient abrasion, no access to EMR or medical records, lack of follow-up care—PCPs reluctantly accepted these inferior methods because they lacked the tools, resources, and time to do this work themselves.

All that changed when Vatica Health pioneered a PCP-centric risk adjustment and quality of care solution supported by expert clinical teams with cutting-edge technology at the point of care. Vatica Health empowered PCPs to “take back” risk adjustment assessments, helping thousands of PCPs dramatically improve care and their financial performance. Then COVID-19 happened.

While CMS significantly expanded telehealth benefits in early March, it did not address the face-to-face requirement for risk adjustment. Fortunately, on April 10, the healthcare ecosystem exhaled a collective sigh of relief when CMS officially approved telehealth as a means of gathering risk adjustment data. And while that’s good news for providers and health plans, rolling out telehealth isn’t as simple as flipping a switch.

With all the challenges PCPs are facing, the last thing they need is another burden. PCPs need turnkey solutions to keep their practices running and their patients healthy. Vatica Health is here to help. We are proud to support your practice by offering clinical and administrative support to get patients back through your virtual doors, and to efficiently perform health plan sponsored risk adjustment and quality of care documentation, via telehealth.

We are a PCP-centric partner, and we are here to help you get through these challenging times.