The World Health Organization (WHO) has agreed that comprehensive primary health care (PHC) is the ‘cornerstone’ of achieving universal health coverage and ensuring the health of populations around the world.
COVID-19 is presenting unique challenges for global primary care, and its response has been varied, inspiring, and also troubling. Inconsistent reimbursement and Low patient volume are hampering cash flow, resulting in layoffs and furloughs. Already being an underfunded area of medicine, primary care has faced major financial challenges throughout the first year of the pandemic. Most clinicians are suffering large decreases in patient volume.
Continued telehealth reimbursement, better-targeted federal relief, and help to acquire personal protective equipment are some ways primary care providers can maintain financial stability as the country enters the second year of the COVID-19 pandemic, according to industry experts. Funds from the federal government and telehealth reimbursement parity were key to surviving higher PPE costs, empty waiting rooms, and other changes in operations during the pandemic. We need to find out what practices need to succeed in this environment and make policies to help support this foundational part of our health care system.
The Provider Relief Fund hasn’t done much to help independent primary care practices. The Provider Relief Fund (PRF) which was established by the Coronavirus Aid, Relief and Economic Security (CARES) Act in March 2020 has distributed hundreds of billions of dollars in aid to healthcare providers. However, the government’s distribution methods have given priority to large hospitals and health systems, leaving most practices with relatively small payments from the initial, automatic distribution.
Instead, primary care practices had to rely more on Paycheck Protection Program funding and advanced Medicare reimbursements. However, hospitals received more upfront Medicare reimbursements, which were basically zero-interest loans if repaid in time, compared to physicians. Outlays in the future from the PRF should be better focused compared to previous payments, in order to support the providers most in need.
In order to ensure that primary care practices have access to sufficient PPE and satisfy the increased demand for telehealth and audio-only service, additional federal support is needed.
It was found that practices adapted rapidly to telehealth and other modes of care delivery as delivering in-person care were not possible due to safety. The transition was comparatively smooth according to the practice leaders. But it was not possible for practices to be successful with telehealth implementation without federal support for reimbursement from the CARES Act.
Providers felt that their shift to telehealth as a significant portion of their interaction with patients was only viable because of altered payment rules and increased reimbursement for telehealth services.
However, the reimbursement policies are not permanent. The private payers who had followed the suit can pull the plug on telehealth reimbursement parity at any time in most states. In addition to that only one state required private payers to waive the requirement of cost-sharing for telehealth visits during the COVID- 19 period although many payers have opted to adopt the policy internally. Deductibles were killing practices financially even before the pandemic.
Primary care practices have started planning the future of telehealth as they have implemented the technology to facilitate visits and have a better understanding of fitting telehealth into appropriate care delivery. Patients have also adapted to virtual care and many have started to prefer telehealth appointments.
However, some private payers are already reinstating cost-sharing requirements and scaling back telehealth reimbursement rates. This is causing concerns among practice leaders that telehealth will not be financially viable. Practice leaders also expressed concerns about payers advising patients to use telehealth-only providers despite these providers not being invested in the long-term health of a patient and resulting in overutilization.
Continued support for telehealth reimbursement would assist struggling practices to maintain patient volumes in the event of more COVID-19 waves as well as with sustaining care transformations beyond the pandemic.
We must make sure that despite the present and logical focus on hospitals, pushing for the role of primary care in achieving health equity through universal health coverage (UHC) is maintained and reinforced. The challenge of integrating Public health, Primary care, and the broader health system has been exposed during COVID-19, and failure to include Primary care within pandemic planning has been highlighted. The need to strengthen health systems, particularly primary care, and the importance of primary care in assisting every nation’s pandemic response has been showcased as the world still struggles with COVID-19.
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