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Save America's independent family doctors

 Save America's independent family doctors

America’s independent family physicians, who serve rural and poor communities and are a linchpin to the health care system during the COVID pandemic, are in dire financial straits. Without help, the majority of these practices may be forced out of existence.

The disappearance of many independent family physicians would result in a lack of access to critical kinds of treatments in already underserved communities where primary care is the lifeline to urgent, chronic and preventive care. When primary care practices disappear, patients often experience poorer health outcomes. 

These physicians are particularly vulnerable now as the nation experiences a rising third wave of the pandemic.

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 “Primary care physicians are central to the health care system and with the onset of the pandemic they are needed more than ever,” said Dr. Robert LoNigro, the president of Healthcare Partners, an independent practice association that works with more than 2,000 independent primary care physicians in the New York metropolitan area. “Independent practitioners had been at risk in the past, but now we are seeing an acceleration of forces and financial pressures that are pushing practices to the brink.”

Primary care physicians are the first line of defense in diagnosing and treating disease, improving the health of patients through preventive medicine, and managing chronic illnesses. They also help patients navigate their way to treatment with specialists and hospitals. And they play a central role in private health plans, Medicare and Medicaid in controlling the quality and costs of care.

Independent primary care doctors are often the only medical professionals available to remote, rural areas and are the highly sought after source of care in underserved black and Latino communities. Almost half of the 210,000 primary care physicians in the United States are independent practitioners.  

This spring, primary care physicians saw a drop in in-person office visits of more than 60 percent as the pandemic spread across the country. Nearly half of primary care physicians, according to one study of doctors in smaller practices, had to lay off or furlough staff. Earlier in the pandemic, 53 percent of all independent physicians reported that they were worried about the practices surviving the financial challenges. 

Although many patients returned during the summer and other patients now see their doctors online, the money coming into primary care practices often does not cover the costs of running offices. Many primary care doctors, who are among the lowest-paid physicians in medicine, have little access to capital. So, they face just two choices: shuttering their practices or selling out to large hospital systems or private equity firms. 

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The situation requires a stronger policy response from the government and insurance companies.

While Congress allocated trillions of dollars of taxpayer money into the coronavirus crisis, scant funds have made it to small physician practices. The CARES ACT paid out about 2 percent of practitioners’ revenue lost as a result of the pandemic. The fact is that smaller practices just do not have the lobbying prowess to compete for funds in Washington.  

Small independent physician practices need aid targeted especially to them. The small business loans they have received from the federal government should be turned into grants. Furthermore, Congress and the administration should provide dedicated grant funding to primary care practices. Some experts estimate that $15 billion could provide a vital lifeline to these practices. 

Another thing health plans and government programs can do — at least during the course of the pandemic — is to advance payments to these practices. For example, the Pacific Medical Business Group on Health and the California Medical Association this year proposed to the California legislature to require health insurers to make $2.5 billion in prospective payments to independent primary-care providers for this year and next.   

But these are just near-term fixes. Private health care insurers and government payers need to preserve primary care in the long run. 

The best way to do so is to move away from fee-for-service payment systems in which physician practices get paid for each service they provide. During the pandemic, the fee-for-service system devasted practices as the number of patient visits declined. Physicians fared much better when they were paid in an alternative, “value-based” payment system that provides a steady stream of income for each patient they treat.

One model payers should look at is the Medicare Comprehensive Primary Care Project which seeks to improve the quality, access, and efficiency of primary care. That public-private partnership, involving 52 payers in 18 regions, provides a quarterly payment for every patient under a physician’s care. The private health plans involved have seen improved financial results for themselves and their primary care physicians. The program is also popular with physicians who work with private insurers.

Independent primary care physicians can play a crucial role in addressing a range of big problems in American health care — from contending with the COVID crisis to managing chronic diseases to improving outcomes for long-underserved minority communities. To do so, they need government and insurance company support to get them through this trying time and, in the long term, new ways of paying for the value they bring to the nation.  

Peter Kerr is the president of Ulysses Communications and is a former reporter for The New York Times.