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Shifts in care delivery methods have been the main theme of primary care changes during the COVID-19 pandemic. With most of the US ordered to stay at home for several months this spring, patients and their primary care providers are adapting to new ways of conducting the typical office visit. The use of telehealth, in particular, has increased significantly in recent months.
Several studies have been conducted to determine how primary care providers are adapting during the pandemic. A professor of management, healthcare systems, and health policy at Northeastern University, Timothy Hoff, has been following doctors in New York to study how they’ve adapted to their new reality. New York has been one of the hardest-hit states, especially at the start of the pandemic.
The doctors that Hoff has been studying serve different types of communities and represent a range of experiences. Some of the providers have been practicing medicine for decades while others are relatively new to the field. The doctors work in urban as well as rural settings.
Hoff noted, “What has struck me already is just the level of resilience that all of these physicians have shown. These healthcare professionals have had to think in brand new ways, or adopt new systems and behaviors, in order to care for their patients.”
“Part of what we’re seeing here is doctors who know their patients very well, who have long-standing relationships with their patients, really stepping up to figure out how to care for them,” he says. “And so, what that means for the future of primary care is a really interesting question.”
Examples from Hoff’s study include a rural setting in upstate New York where physicians and nursing staff installed a Wi-Fi hotspot in their parking lot so their patients could use their phones and other electronic devices for virtual appointments. Many of the doctors have had to set up telehealth systems to deliver care to their patients.
Adaptation and innovation have been key to quality healthcare delivery for these providers. One physician conducted exams in the back of his patients’ pickup trucks, fully protected in personal protective equipment. Another provider in the study was able to correctly diagnose a fractured hip in an elderly patient during a virtual visit.
A separate study conducted by researchers at New York University (NYU) found that many of that city’s primary care practices have been hit hard by the effects of the COVID-19 pandemic and they worry about their survival. Out of almost 500 primary care practices participating in the survey, 85% indicated the pandemic was having a severe impact on them. More than half of the patient visits conducted by those primary care practices that have been able to remain open were conducted by video or telephone.
Dr. Donna Shelley, professor of public health policy and management at the NYU School of Global Public Health, who is leading the research, said, “We all understand that the crisis is at the hospital level, but what’s remarkable is that in the midst of this overwhelming crisis of hospitalizations, people were forgetting there are other front line healthcare workers, and they’re called primary care doctors and nurses.”
Telehealth is becoming the norm for primary care visits. The AMA reports that physicians are now seeing 50 to 175 times the number of patients via telehealth than they did before the pandemic. 46% of patients are now using telehealth to replace the in-person visits that have been canceled because of COVID-19. In addition, 57% of providers view telehealth more favorably than before COVID-19 and 64% report that they are more comfortable using it.
With the Centers for Medicare & Medicaid Services (CMS) temporarily allowing more than 80 new services to be conducted via telehealth, consumers’ preferences for telehealth could become more deeply embedded into the care delivery system while the nation continues to social distance during this health emergency.
Justin Egkan September 4, 2020Read
At one point not too long ago, telehealth was new and innovative – and rarely used. With the COVID-19 pandemic, telehealth has become the preferred method of healthcare among many physicians and their patients. Since primary care practices are reducing their office hours or closing altogether during the outbreak, patients are often only able to connect with them virtually. COVID-19 is normalizing the use of telehealth for the foreseeable future.
The U.S. Department of Health and Human Services (HHS) defines telehealth as the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, and public health and health administration. Technologies include
Although primary care physicians have, for the most part, rescheduled routine visits with their patients, they are using telehealth for virtual visits with patients who have illnesses or injuries that cannot be postponed. Previous concerns about privacy and HIPAA regulations have been alleviated by relaxed restrictions and enhanced technology.
The DHHS Office for Civil Rights (OCR) expects health care providers will ordinarily conduct telehealth in private settings, such as a doctor in a clinic or office connecting to a patient who is at home or at another clinic. Providers should always use private locations and patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances. If telehealth cannot be provided in a private setting, covered health care providers should continue to implement reasonable HIPAA safeguards to limit incidental uses or disclosures of protected health information (PHI). Such reasonable precautions could include:
Primary care physicians are finding additional benefits to using telehealth for patient visits. Bob Kocher, MD, a senior fellow at the USC Schaeffer Center, recently wrote that “with virtual visits, doctors can check in with sicker patients more often and can learn more about them by seeing their living environments through video.” Providers can check on the patient’s housing conditions, as well as whether they have pets that may affect their medical condition. They can also see whether patients have the proper food and social support, factors they cannot always learn about in an office visit.
Dr. Kocher adds that it’s “easier to provide more thorough and comprehensive care through telemedicine. It is better for patients to have their doctors coordinate care, and far easier to do it together with the patients in real time.” Telehealth visits enable collaboration through group chats that reduce much of the time and information that “is lost between visits from primary care doctors to specialists.”
The COVID-19 pandemic has been challenging for everyone and especially for those who need healthcare from their primary care physicians that is not related to the coronavirus. As Dr. Kocher emphasizes, though, “One silver lining is that virtual care will become a much integral part of healthcare for all us, and this will lead to better care and more accessible care.”
Justin Egkan July 14, 2020Read
The term “primary care” was first introduced in the US in 1961. Though most people have referred to their “family doctor” throughout history, in the 1960s primary care came to be known as separate care from that provided by a growing number of specialists. In fact, primary care was so named because the primary care physician is typically the first stop for a patient who may need additional services such as a visit to a specialty provider or laboratory.
In 1966, the Millis Commission defined the primary care physician as a physician who “will serve as the primary medical resource and counselor to an individual or a family. When a patient needs hospitalization, the services of other medical specialists, or other medical or paramedical assistance, the primary physician will see that the necessary arrangements are made, giving such responsibility to others as is appropriate, and retaining his own continuing and comprehensive responsibility.”
Today, the primary care physician quite often acts as the medical home for the patient, coordinating care with specialty providers, laboratories, and healthcare facilities. The primary care physician “listens to the patient, makes diagnoses, manages, and screens for other health care problems. The clinician educates and communicates with the patient and others who may be involved including other specialists when appropriate.”
Primary care is being recognized for its importance in the quality of healthcare in the US. Many states are emphasizing the need for sufficient funding and appropriate legislation to prioritize primary care.
Primary care providers can include physicians, physician assistants, and nurses. Providers get to know their patients, use technology such as electronic health records (EHRs) to track and manage their patients’ medical information, and work with the patients to ensure their healthcare plan is effective. The primary care physician can play a significant role in improved quality of care as well as reduced healthcare costs.
Justin Egkan July 1, 2020Read
Primary care physicians are caught between their mission to provide quality healthcare to their patients and sustaining their practice during the extreme challenges of the COVID-19 pandemic. Patients are confused and concerned about whether they can see their primary care provider for regular, preventive care. They also need a place to go for testing when they suspect they may be infected with the virus.
Primary care physicians are adjusting, shifting to telehealth, but they and their patients are still uncertain and anxious. Even before the COVID-19 pandemic began, the US was seeing declines in the rate of primary care visits, in the percentage of Americans who had a “usual source of primary care,” and in the level of overall trust in providers.
A number of surveys have been conducted recently to determine how primary care physicians and their patients are responding to the coronavirus restrictions and guidelines. The results of several of those surveys include:
The Centers for Disease Control and Prevention (CDC) is encouraging the increased use of telehealth to help ensure the health and safety of both primary care providers and patients.
A survey conducted by the Primary Care Collaborative and The Larry A. Green Center found that:
To assist primary care physicians who may need further guidance on continuing to operate during the crisis, the American Medical Association (AMA) has compiled a list of resources, including information on elective procedures, diagnosing patients, Medicare and Medicaid coverage, and protecting the practice and the patients during COVID-19.
Elation Health supports the work of primary care physicians as well, and has launched the COVID-19 Resource Center for independent physicians, providing the latest updates and guidelines and enabling providers to focus on their patients.
Justin Egkan June 30, 2020Read
While many hospitals are overwhelmed caring for COVID-19 patients, many primary care practices are reducing services as well as staff during the pandemic. Some are even having to close due to the lack of funds to keep their practice going through the outbreak. Industry experts are urging healthcare payers, including government entities, to take significant steps toward addressing primary care payment now and for the longer term.
In an April 2020 letter to House and Senate leaders, AAFP Board Chair John Cullen, M.D., of Valdez, Alaska, wrote that “This public health crisis has identified significant cracks in our country’s primary care infrastructure. Population health will only be achieved when we identify and remove the barriers that exist.” The letter added that Congress now has “the opportunity to address systemic issues that have been plaguing primary care and the health care system more broadly.”
AAFP emphasizes that “as primary care goes, so goes the health of Americans, including millions with chronic health conditions.” When primary care practices face financial difficulties, it sends “a disruptive ripple across the entire US health care system, affecting countless patients.” In fact, AAFP says, “if Congress fails to address the sudden financial stress on primary care, the closure of more practices will disrupt the entire health care system.”
Elation Health is committed to help primary care practices throughout the COVID-19 pandemic. Please check out our COVID-19 Financial Guide, designed to help you succeed in dealing with the economic effects of COVID-19.
Joshua M. Liao, MD, MSc, medical director of payment strategy at UW Medicine in Seattle and an assistant professor in the Department of Medicine at the University of Washington School of Medicine, writes recently in MedPage Today that “Primary care is central to all phases of our pandemic response.” He notes that “in the longer term, the COVID-19 battlefront may shift almost entirely to primary care.”
Dr. Liao goes on to emphasize that:
COVID-19 provides an urgent rationale for leaders to prioritize policies that increase primary care reimbursement. These efforts were already underway many months ago, with public payers such as Medicare setting policy in motion to increase reimbursement for office visits. Such changes should go into effect as planned in January 2021, and ideally alongside newer accommodations such as reimbursement for telehealth visits.
The challenge with this timeline, Dr. Liao clarifies, is that the primary care practices that are currently struggling will have to survive through the end of the fiscal year. He adds that, because of this, “policymakers should also provide primary care providers more immediate financial support.”
He writes also that “solving the primary healthcare crisis will require more than payment changes.” The definition of primary care that currently differs among various stakeholders should be consistent and the issue of coordination must be resolved, as “payment changes enacted by insurers will be useful only if practices implement processes that improve outcomes.”
An article published by the Center for Health Care Strategies, Inc., highlights the fact that federally qualified health centers (FQHCs), “the first line of defense in underserved communities, serving primarily Medicaid patients and the uninsured” are also facing dire financial situations. In fact, many FQHCs may also be forced to close because of the coronavirus outbreak, either temporarily or permanently.
The solution for primary care may lie in prospective payment models, such as capitation or global payments, which “pay providers, teams, or organizations a predictable, upfront per-member-per-month (PMPM) payment to take care of a patient. Providers receive these payments whether they perform services for the patient or not. They are intended to:
The writers suggest that “such models could be deployed quickly – with health plans or government payers providing PMPMs based on last year’s utilization, offering a short-term solution for provider cash flow problems.”
Justin Egkan June 16, 2020Read
Your job as a primary care physician is stressful. You are charged with providing high quality, value-based healthcare to your patients and with running a successful business in your practice. Regulations, paperwork, and patient and staff needs can pile up, causing more stress and, eventually, burnout. While the rate of burnout continues to be high, there are a number of physicians fighting burnout in unique ways.
A whopping 92% of physicians participating in the Medical Economics 2019 Physician Burnout Survey said they felt burned out from practicing medicine at some point in their career. The survey also found that:
There are physicians fighting burnout, some in very creative ways. Gabe Charbonneau, MD, a family physician in Stevensville, Montana, has developed a “Fight Burnout” logo and slogan which he has printed on t-shirts. He then sends those t-shirts to other physicians and people who are doing something meaningful to fight burnout, along with a note of thanks.
Dr. Charbonneau’s shirt features a phoenix rising above the ashes with the Rod of Asclepius and “We rise above” written in Latin, “Nos ortum superare.” He knows first-hand the effects of burnout, as his wife had to leave their family practice because of her own burnout symptoms. Dr. Charbonneau is focused on spreading the word that “burnout doesn’t have to be the accepted norm.”
Other physicians fighting burnout include Daisy Smith, MD, FACP, American College Of Physicians (ACP) vice president for clinical education, Philadelphia. Dr. Smith is leading ACP’s efforts to build awareness about burnout among physicians, including educating them as to how they can identify the warning signs. She says, “We need to fix the water clinicians are swimming in,” adding that “The overall causes of burnout are a workload where people keep adding more and more things to front-line clinicians, but nothing gets taken away.”
Marie Brown, MD, Internist and AMA practice transformation officer, Oak Park, IL, is focused on developing ways to streamline her daily activities to reduce her stress. When using electronic health records (EHRs), she suggests reviewing the types of notifications selected. For example, she says that she has turned off notifications about discharge summaries and tests that did not include results, as those are not useful to her in her daily work. Dr. Brown also suggests that physicians should be properly trained on using their EHRs more efficiently.
At Elation Health, we designed our clinical first, cloud-based EHR to take less than an hour to learn!
In an effort to fight burnout and its potentially devastating effects, many physicians and organizations, including the American Medical Association (AMA), are studying and addressing the issues fueling physician burnout. As Dr. Charbonneau emphasizes, everyone can “make a difference” in the fight to combat physician burnout.
Justin Egkan June 12, 2020Read
The possibility that one of your patients or one of your staff could test positive for COVID-19 is very real. Depending on your location, the probability increases if you are caring for patients in vulnerable populations, such as the elderly and those with chronic conditions.
While providing care using telehealth options is preferred during the coronavirus outbreak, you may need to see certain patients face-to-face. Taking appropriate precautions can help you reduce the potential for infection in the office as well as when you return to your home:
Check out Elation Health’s COVID-19 resources, full of helpful information for your independent practice during the pandemic.
The American Medical Association (AMA) has some additional guidance on what to do when COVID-19 enters your practice, based on the experience of a medical practice in Houston that has treated three patients with the coronavirus:
The Centers for Disease Control and Prevention (CDC) has provided print resources that can be used in your practice, to advise your patients on what they need to do before entering your practice and if they have COVID-19 symptoms. Use these resources to keep your patients and your staff informed, safe, and healthy.
Justin Egkan June 2, 2020Read
May is Mental Health Month. The coronavirus outbreak has made many people feel worried, depressed, and concerned about the current situation as well as about what the future holds. In addition to caring for your patients’ physical health during the COVID-19 pandemic, you may also need to help them cope with anxiety, so this is a good time to review ways to do just that.
Psychiatrist Dimitrios Tsatiris, MD, offers these tips for you as a primary care physician to guide your patients through the anxiety of this crisis:
Elation Health supports you and your practice throughout the pandemic.
Check out our COVID-19 Resources here.
The CDC also offers a list of tips for coping with stress during the COVID-19 pandemic, that can be helpful to share with your patients:
Justin Egkan May 26, 2020Read
Primary care practices are small businesses and, as such, are challenged with remaining financially viable during COVID-19. Primary care physicians and their staff are also struggling with their main goal of providing appropriate and quality healthcare to their patients. Many have shifted to telehealth services but are finding that patients may not have the resources to access the proper technology. Several recent surveys and research studies show what is happening with primary care during the coronavirus outbreak.
In attempt to keep everyone safe and healthy, primary care practices are actively discouraging patients from visiting their office for routine care. In fact, fewer than 20% of the usual visits are now held in person. Insurers are paying for telemedicine visits in an effort to accommodate the situation, but Medicare is currently reimbursing virtual visits at approximately half the fee of in-person visits.
A weekly survey conducted jointly by the Larry Green Center and the Primary Care Collaborative sheds light on what is happening with primary care during COVID-19. The survey conducted of 1,000 primary care clinicians during the week of April 3-6, 2020, revealed that:
In the follow-up survey, conducted April 10-13, 2020, findings regarding frontline primary care clinicians’ experience with COVID-19 included:
Specific Main Findings
Virtual Health Findings
Survey respondents also indicated that financial vulnerabilities are high. Over the next 4 weeks:
Primary care physicians writing in a recent issue of StatNews emphasized that “The Covid-19 crisis is revealing the financial peril of relying on billable, in-person visits as the main way to pay for primary care, which provides little backstop in times of crisis.” They encourage heeding “the lesson of the Covid-19 crisis to protect primary care in a foundational way that will matter even more once the pandemic is over.”
Justin Egkan May 19, 2020Read
Even as we are following social distancing guidelines and orders to stay at home, it still becomes necessary occasionally to make a trip to the grocery store. Many people have questions about what to do while shopping and after arriving home with the groceries to make sure they stay safe and healthy. COVID-19 grocery shopping tips for patients can alleviate some concerns during these challenging times.
Dr. Jeffrey VanWingen, an independent family medicine physician in Michigan, has offered some very important tips on applying medical sterilization techniques to grocery and takeout food via an informational video. Dr. VanWingen advises his viewers to think of their groceries as being covered with glitter. The goal when you arrive home is to not have any glitter on your groceries, your hands, or especially your face. Then imagine that disinfectants and soaps have the power to get rid of all the glitter.
Dr. VanWingen offers the following tips for grocery shopping:
When you bring your groceries home:
If you decide to use a shopping service, don’t let them come into your home when they deliver. Have them leave the groceries outside instead so you can bring them and follow the sanitizing guidelines. As Dr. VanWingen emphasizes, “safety out in the marketplace can literally save lives.”
These tips are important for your safety while you are shopping and when you bring your groceries home, since you can acquire the coronavirus through the air and after touching contaminated objects. Researchers have found that COVID-19 can remain on surfaces for several hours to several days, depending on the type. The virus is detectable up to:
Following Dr. VanWingen’s sterilization techniques can be a significant factor in your health and safety. As James Lloyd-Smith, co-author of the study that supports guidance from public health professionals to slow the spread of COVID-19, and a UCLA professor of ecology and evolutionary biology stated, “If you’re touching items that someone else has recently handled, be aware they could be contaminated and wash your hands.”
Justin Egkan May 12, 2020Read