Population Health During a Pandemic: What Physician Practices Can Do to Weather the Storm and Come Out Ahead

by | Oct 19, 2020 | Blog

As of August 21, the US had more than 5.5 million confirmed cases of COVID-19, with more than 174,000 deaths.[1] While the number of cases has decreased in most regions, other areas are now in an upswing. The same is true in other countries around the globe. It’s clear at this point that the virus isn’t going away anytime soon. And now we’re about to enter flu season, which experts predict could be a “perfect storm.”[2] It’s just too soon to tell what the impact might be.

All of this is not good news for physician practices still trying to get back to some semblance of normal. According to Medical Group Management Association (MGMA), “97% of practices have experienced a negative financial impact directly or indirectly related to COVID-19.”[3] Much of the impact stems from the decrease in patient volumes, up to 60% for some practices. Many practices have downsized to just the bare minimum of staff needed to stay open to mitigate the damage. Another trend is that physicians and employees have taken pay cuts, some as much as 50%. Others, still, have turned to GoFundMe campaigns as a way to help keep their doors open.[4]

MGMA reports that practices have experienced an average decrease in revenue of 55% due to COVID-19.[5]

Alongside cost-cutting and fund-raising measures, many practices have taken loans through the CMS APP (Advanced Payment Program). But as the virus is still spreading in many areas of the country, and with the expectation that it may reappear in the fall, repaying those loans could be a problem. And at an interest rate of 9.625% and just 120 days to repay the loan before recoupment begins, what was intended to be a financial bridge for physicians may actually add even greater financial pressure. According to HFMA, “Even absent the lag effects of the COVID-19 pandemic, we do not believe it is possible for some providers to deliver a sufficient volume of services to repay the APP Program loan and sustain ongoing operations.”[6]

Practices could see revenue losses of more than $75,000 per full-time physician due to COVID-19.[7]

Telehealth expansion

Four years ago, just 16% of physicians said their practice used telehealth.[8] That number jumped to an estimated 97% upon the arrival of COVID-19. Fortunately, the CMS has relaxed requirements around telehealth and, on March 27, expanded reimbursement for telehealth services. Medicare payments for telehealth now cover patients no matter where they live and include services performed by practitioners other than the physician.[9]

 More than 16 million Americans say they used telehealth for the first time during the pandemic[10]

Even before the pandemic, we understood that achieving positive outcomes requires ongoing care outside of the exam room, especially for those with chronic diseases, which is now the majority of the population. The expansion of telehealth during the pandemic supports the implementation of CCM (chronic care management) and RPM (remote patient monitoring). This opens up new revenue potential. Providers can get $42 per month for each patient enrolled in a CCM program. If only 50% of eligible patients are enrolled in a CCM where care is provided by an LPN, RN, or MA, providers could see $75,000 in net new revenue per provider.

Telehealth-enabled CCM and RPM also increase care plan adherence and provide improved outcomes and a more holistic, patient-centric healthcare experience.[11] And isn’t this what population health is all about?

We don’t yet know which of the CMS changes will become permanent once the pandemic has gone. But one thing is for sure: Physician practices would be wise to take full advantage of the changes as they are now, not just to weather the pandemic storm, but also to identify ways to leverage these changes ongoing. Telehealth is a prime example. Telehealth is queued up now; the technology is in place, workflows are established, and, for the most part, patients have accepted virtual care as part of the “new normal.” Now is the right time to double down on telehealth as a conduit for a more effective continuum of care and a more financially sustainable future for physician practices.

[1] https://coronavirus.jhu.edu
[2] https://science.sciencemag.org/content/368/6496/1163
[3] https://www.mgma.com/getattachment/9b8be0c2-0744-41bf-864f-04007d6adbd2/2004-G09621D-COVID-Financial-Impact-One-Pager-8-5×11-MW-2.pdf.aspx?lang=en-US&ext=.pdf
[4] https://jamanetwork.com/journals/jama/fullarticle/2767633
[5] https://www.mgma.com/getattachment/9b8be0c2-0744-41bf-864f-04007d6adbd2/2004-G09621D-COVID-Financial-Impact-One-Pager-8-5×11-MW-2.pdf.aspx?lang=en-US&ext=.pdf
[6] https://www.hfma.org/topics/coronavirus/cares-act-payback-problem-for-some-healthcare-providers-.html
[7] https://www.hfma.org/topics/coronavirus/covid-19-impact-on-independent-primary-care-physician-practices-.html
[8] https://www.businessinsider.com/telemedicine-will-boom-but-barriers-persist-2019-3
[9] https://www.federalregister.gov/documents/2020/05/08/2020-09608/medicare-and-medicaid-programs-basic-health-program-and-exchanges-additional-policy-and-regulatory
[10] https://www.pwc.com/us/en/library/covid-19/covid-19-consumer-behavior.html
[11] https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf

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