Primary care agencies struggling to survive under Covid-19

Cormay Caine skips an all-day job and drives more than 130 miles back and forth to take her five children to her pediatrician. The Sartell Clinic in Minnesota, where their doctor previously worked, closed in August.

Caine is one of the parents who followed Dr. Heather Decker to her new location on the outskirts of Minneapolis, an hour and a half. Many could not get an appointment with nearby flooded doctors for months.

“Somehow I destroyed him leaving because I don’t like to change providers and my kids were used to him. He’s just a fantastic doctor,” said Caine, a postal worker who recently piled the kids in her car. back-to-back meetings. “I just wish you didn’t have to go that far.”

So does Decker, who hoped to settle in the Sartell area. He recently bought his four-bedroom “dream house” there.

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The HealthPartners Central Minnesota Clinic, where Decker worked, was the victim of a Covid-19-related closure wave that is beginning to blur across America, reducing access to care in areas where primary care is already scarce.

Although no one is following medical closures, recent research shows there are thousands. According to a survey by the Medical Foundation, 8 percent of all practices nationwide — about 16,000 — closed in the stress of the epidemic. This survey did not break them down by type, but another Virginia-based Larry A. Green Center and Primary Care Collaborator found in late September that 7 percent of primary care practices were unsure whether they could stay open over December without funding. . aid.

What this epidemic has done puts a lot of emphasis on what was already a big crack in our healthcare system back then.

And much more is imminent in the economy, experts say.

“Recent years have been difficult for primary care practices, especially for the independent,” said Dr. Karen Joynt Maddox, co-chair of the Center for Health Economics and Politics at the University of Washington in St. Louis. “On top of Covid in many cases, it’s the proverbial straw. These exercises don’t work with huge margins. They just mature.”

When offices close, experts say the biggest losers are patients, who can skip preventive care or regular appointments that help keep chronic diseases like diabetes under control.

“It’s especially poignant in rural areas. There are no good decisions. What happens is people end up in the emergency department,” said Dr. Michael LeFevre, a Columbia doctor in Missouri who has a family and community medicine department at the University of Missouri. “If anything, this epidemic puts a lot of emphasis on what was already a big crack in our healthcare system back then.”

Federal data show that 82 million Americans live in “health care shortages” of primary care, and the country needed more than 15,000 additional primary care even before the pandemic began.

After the coronavirus was struck, some practices were amazed when patients stayed away en masse for fear of being caught, said Dr. Gary Price, president of the Doctors Foundation, a nonprofit support and research organization. His survey, based on 3,513 responses from emails sent to half a million physicians, found that the number of patients had dropped by more than a quarter in 10 practices.

According to a survey released last month by the California Medical Association, revenues fell by at least half in a quarter of the state’s practices. One respondent wrote, “We’ll close next month.”

Decker’s experience with HealthPartners is typical. Before the epidemic, he saw about 18 patients a day. It quickly dropped to six or eight, “if it did,” she said. “There were no well inspections, which is the bread and butter of pediatrics,” he said.

In a statement sent by e-mail, HealthPartners officials, which have more than 50 primary care clinics in the Twin Cities and western Wisconsin, said closing the Sartell clinic was “not an easy decision,” but the epidemic caused an immediate, significant setback. income. While he continued his dental care in Sartell, northwest of Minneapolis, the company encouraged employees to apply for open positions elsewhere in the organization. Decker got one. Officials also posted information online for patients about where more than 20 doctors are moving.

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The financial waves of the pandemic have shaken all kinds of practices, said LeFevre, a Missouri doctor. Before the epidemic, he said, a total of 3,500 patients were seen weekly at 10 clinics in his group. Covid-19 temporarily halved the number.

“We had budget reserves to deal with the storm. Small practices often don’t have that. But it’s not like we went unharmed,” he said. “The staff was paid for a week’s rent. All providers made a 10 percent pay cut for three months.”

According to federal data, pediatricians earn an average of $ 184,400 a year, while general practitioners earn $ 201,400, making primary care physicians one of the lowest paid physicians.

As revenues from medical practices declined, overhead costs remained unchanged. And the practices had to face new costs, such as personal protective equipment, which became more expensive as demand exceeded supply, especially for small practices, without the mass purchasing power of the big ones.

Doctors have lost money in other ways as well, said Rebecca Etz, co-chair of the Green Center research group. For example, he said pediatricians paid for vaccinations in advance, “then when no one came in, they expired.”

Some physicians have taken out a loan or claimed money from the Service Provider’s Relief Fund under the federal CARES Act. Dr. Joseph Provenzano, who practices in Modesto, California, said his group of more than 300 doctors received $ 8.7 million in aid in the early days of the pandemic.

“We were getting ready to go down,” he said. – It came at the peak of time.

While the patient loads in the group largely rebounded, they still had to close three of the 11 clinics permanently.

Said Dr. Ada Stewart, president of the American Academy of General Practitioners, “We need to keep the doors of practice open so we don’t lose access, especially now that people need it most.”

Caine, a Minnesota mother, said she suffered from her own health care because she also saw providers at the closed Sartell clinic. While looking for new ones, he had to deal with him in the emergency care offices and the emergency department.

“I’m lucky because I can do it. I’m able to improvise. But what about families that don’t have transportation?” he said. “Older people and sicker people really need these services and they have been deprived.”

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