The day will come when the COVID-19 pandemic is lastly behind us. Consultants warning that the viability of the well being care system that awaits on the opposite aspect of the pandemic may hinge on which entities have the monetary wherewithal to outlive the disaster and thrive in its aftermath. Among the many well being care organizations on the biggest monetary threat because of the pandemic are unbiased major care practices, which in current months have reported drastic reductions in go to volumes and observe income. An unpublished evaluation of Blue Cross North Carolina (NC) industrial claims knowledge present a significant drop in income for unbiased major care practices in North Carolina—an 11 p.c discount from baseline common industrial income per observe via the tip of May in comparison with the identical interval in 2019. Impartial major care practices are small companies which are notably inclined to the monetary volatility of the predominant fee-for-service fee system, which has been upended by the COVID-19 pandemic. These practices are at excessive threat for closure, and they’re targets for acquisition by higher capitalized entities that embrace well being methods, payers, and personal fairness companies.
Telehealth Is Not Sufficient To Save Main Care
COVID-19 has catalyzed main modifications for unbiased major care practices. For instance, from January to June 2019, just below 5 p.c of unbiased major care practices in our community had a telehealth declare submitted for fee, and through the identical interval in 2020, this proportion was greater than 75 p.c. Utilizing the identical intervals of comparability, our knowledge present that the proportion of unbiased major care suppliers’ income from telehealth delivered to commercially insured members has practically doubled, from 4.three p.c to eight.1 p.c. Since Blue Cross NC instituted fee parity for telehealth in March 2020, telehealth has accounted for greater than 18 p.c of our taking part unbiased major care practices’ whole industrial income. However the truth that 1 / 4 of unbiased major care practices in our community haven’t adopted telehealth regardless of the brand new fee coverage exhibits that telehealth shouldn’t be thought of a panacea for the monetary disaster in major care.
Three Causes Why We Want To Care About Impartial Main Care Practices
The monetary challenges going through unbiased major care matter for 3 causes. First, unbiased major care practices are an indispensable entry level within the well being care supply system. These practices, particularly small, physician-owned practices, sometimes provide customized service that’s attentive to particular person affected person and neighborhood wants. Small practices usually tend to be in rural areas, lots of which have doctor shortages. Roughly 26 p.c of unbiased major care suppliers in our community observe in rural areas of North Carolina. Monetary misery resulting in closure of unbiased major care practices or furloughing of their workers would additional restrict entry to well being companies in areas already experiencing entry challenges.
Second, the monetary misery of unbiased major care practices may gas extra consolidation in well being care. Consolidation via acquisition of unbiased major care practices would drive up spending on major care, a end result that may not essentially be problematic. Larger ranges of funding in major care are acceptable in the event that they led to higher care, not in the event that they merely replicate suppliers’ market energy. Proof means that consolidation will result in elevated well being care prices, and there’s no assure that it’s going to enhance entry or high quality of care. Nevertheless, it would definitely scale back shopper alternative.
Third, there may be proof that in comparison with hospital or well being system-owned practices, unbiased major care practices may have higher high quality and value outcomes underneath various fee models. For any given industrial inhabitants of sufferers, unbiased major care practices’ direct income as a proportion of whole price of care is low. As a result of they don’t seem to be affiliated with hospitals, unbiased major care practices are higher incentivized than hospital-owned practices to cut back downstream, pointless prices equivalent to avoidable hospitalizations. In value-based fee preparations, these financial savings aren’t misplaced earnings to the unbiased major care practices; as an alternative they function monetary alternatives. Medicare beneficiaries served by unbiased major care practices have fewer preventable hospital admissions than these with major care physicians in hospital-owned practices. Accountable care organizations run by unbiased doctor teams have demonstrated important price financial savings in comparison with hospital- or well being system-owned practices.
Safeguarding The Future Of Impartial Main Care Requires Performing In the present day
With out swift motion to safeguard unbiased major care, the COVID-19-induced monetary disaster may irrevocably change the composition of the nation’s well being care system. To assist major care practices climate extreme financial misery and survive into the post-COVID-19 world, we should first determine funding mechanisms to stabilize observe income. One strategy is for payers to offer supplemental funds to unbiased major care practices that may keep 2020 and 2021 income on the pre-COVID 2019 baseline. Given the volatility of income and the unevenness through which unbiased major care practices may expertise an uptick in demand throughout 2020 and 2021, there ought to be a mechanism for periodic infusions of further funds to make sure practices can stay near their pre-COVID ranges.
Income stabilization funds alone seemingly is not going to enhance entry or spur the power to higher coordinate care, scale back use, or scale back whole price of care. Payers ought to couple these makes an attempt at stabilization with an accelerated transition from fee-for-service reimbursement to value-based fee, which supplies a extra sustainable working model Savvy major care practices can overcome the monetary challenges related to the pandemic’s suppression of demand by taking the chance to leapfrog to population-based, major care doctor capitation fee models. In these models, PCP capitation sometimes is structured as a set fee for a basket of companies. Latest models embrace accountability for high quality enchancment and keep away from incentives to disclaim wanted care. In gentle of the monetary uncertainty of COVID-19, major care clinicians are reawakening to the potential advantages of capitation, which may provide extra predictable financing and lesser administrative burden than fee-for-service fee. When mixed with accountability for whole price of care, PCP capitation may unlock further alternatives for practices to undertake new, modern scientific care models, equivalent to behavioral well being integration with major care. Inhabitants-based major care funds may higher allow practices to undertake new expertise, equivalent to telehealth, and implement team-based care with nurses, pharmacists, social staff, and scientific educators. Below population-based, major care physicians capitation models, major care practices’ income is not primarily based on the quantity of in-person visits, and funds account for the bills related to team-based and technology-enabled care. These fee preparations additionally may be designed to incentivize enhancements in scientific high quality and entry and to assist scale back pointless, low-value care.
We must always by no means let a disaster go to waste. We now have a novel alternative to revisit how we value and pay for major care. The alternatives we make in the present day in responding to the unbiased major care disaster throughout the pandemic will form the supply system we’ve got the day after tomorrow, when COVID-19 is behind us.
Rahul Rajkumar is on the advisory boards of Advantia Well being and OM1. Azalea Kim is on the advisory board of Prepped Well being.