How COVID-19 Is Accelerating the Death and Rebirth of Medical Practices

The COVID-19 outbreak in the U.S. has turned everyone’s world upside down. In healthcare, no one has had their world turned upside down more than doctors and their medical practices. The good old days of burnout, huh?

Over the past several weeks, a number of reports, surveys, polls and research papers have documented how the coronavirus pandemic is affecting medical practices from both a practice model standpoint and from a business standpoint. Medical practices, after all, are businesses, and how doctors run them will determine how well their businesses do financially. 

Without judgment, here’s what the reports, surveys, polls and research papers are saying about what’s happening to medical practices right now because of COVID-19.

The Medical Group Management Association surveyed 724 doctors in early April on how the outbreak is affecting their practices. The MGMA said 75 percent of the respondents work in independent medical practices that employ fewer than 50 full-time equivalent physicians.  

• 97 percent said COVID-19 has had a direct or indirect negative financial impact on their practices 
• 70 percent said they’ve had to lay off or furlough staff to cope with the negative financial impact
• 60 percent said their practices have experienced a decrease in patient volume
• 55 percent said their practices have experienced a decrease in revenue

You can download a copy of the MGMA’s survey results here. 

The Primary Care Collaborative surveyed 2,602 doctors in mid-April on how the outbreak is affecting their practices. The respondents work in family medicine, pediatric, internal medicine, geriatric and urgent care practices and settings. Fourteen percent said they own their own practices.  

• 75 percent said the COVID-19-related stress on their practices is “severe” or “close to severe”
• 65 percent said they have patients who they can’t treat virtually because the patients don’t have computers or internet service
• 47 percent said they’re not sure they have enough cash on hand to stay open
• 43 percent said they’re not sure they have enough patient volume to stay open

You can download a copy of the PCC’s survey results here. 

AbelsonTaylor, the Chicago-based health and wellness ad agency, surveyed 500 physicians in late March and asked them how COVID-19 is affecting what they do and how they do it. 

• 84 percent said they saw fewer patients in late March compared with the same period last year
• 73 percent said they’re writing prescriptions without an office visit because of COVID-19
• 40 percent said they saw patients via telemedicine in late March compared with 18 percent during the same period last year
• 38 percent said they’ve changed their prescribing practices because of COVID-19

You can download a copy of AbelsonTaylor’s survey results here. 

Merritt Hawkins, the Dallas-based physician search firm, polled 842 physicians across the country about how COVID-19 is affecting their practice patterns and direction. The firm released the results April 22.

• 48 percent said they were treating patients via telemedicine compared with 18 percent in 2018
• 21 percent said they’ve either been furloughed or taken a pay cut because of COVID-19
• 18 percent said they plan to retire, temporarily close their practices or leave their patient care roles because of COVID-19
• 14 percent said they plan on changing their practice settings because of COVID-19

You can download a copy of the Merritt Hawkins survey results here. 

The Commonwealth Fund published an analysis of outpatient visit data by Phreesia, a New York-based health IT company that provides “patient intake management” software to medical practices. The data comes from more than 50 million outpatient visits each year to single-specialty practices, multispecialty practices, Federally Qualified Health Centers and large health systems all of which are Phreesia clients. Data from more than 1,600 organizations with more than 50,000 individual physicians is included in the analysis. According to the analysis, which the Commonwealth Fund published April 23: 

• Total outpatient visits dropped 54 percent from March 1 through April 16
• Telemedicine visits represented 30 percent of all outpatient visits on April 16 compared with zero on March 1
• The six medical specialties that saw the biggest percentage drop in outpatient visits between March 1 and April 9 were: ophthalmology (79 percent); otolaryngology (75 percent); dermatology (73 percent); surgery (66 percent); and pulmonology and urology (both 63 percent)
• Behavioral health saw the smallest percentage drop in outpatient visits between March 1 and April 9 at 30 percent

You can download a copy of the Commonwealth Fund’s analysis here. 

If you know me or have read anything I’ve written over the past 37 years covering healthcare, you know that I’m in no way, shape or form an apologist for physicians or big associations and specialty societies that represent physicians. 

But, from a purely economic standpoint, the COVID-19 outbreak is smashing their traditional business model all to pieces. You have to feel for them as you would feel for any businessman or businesswoman whose careers and livelihoods are being eaten away empty exam room by empty exam room. 

EHRs couldn’t do it. Value-based reimbursement couldn’t do it. Artificial intelligence couldn’t do it. But this nasty little virus can and is, if you believe results of all these reports, surveys, polls and research.

So what will be the outcome of all of this for medical practices? Some fear that it will lead to practices closing, being sold or consolidating—all of which could mean less competition and higher prices. That’s certainly possible.

I hope it leads to the rebirth of the medical practice as something completely new like:

• Let’s triage you with our chatbot. 
• Let’s diagnose you via a telemedicine visit.
• Let’s have you come in for a visit now.
• Let’s have you meet with our behavioral health consultant and social worker while you’re here.
• Let’s write you a prescription electronically without an office visit.
• Let’s tell you what our prices are before you come in and how much you’ll pay out-of-pocket.
• Let’s make sure we’re in your network so you’re not hit with a surprise medical bill.
• Let’s monitor your health status and adherence to your treatment plan with this phone app.
• Let’s give you a link so you can access your medical record.
• Let’s send your medical record electronically to everyone you see for care.

This is a break point in the evolution of the medical practice. Will the old model die out and be replaced by the new model? Or, will the old model come back stronger than ever and keep the new model at bay for years to come?

To learn more on this topic, please listen to our April 24 4sight Friday Roundup podcast during which we talk about the impact COVID-19 is having on medical practices.

What do you think is going to happen? Drop me a line at david.burda@4sighthealth.com. 

Thanks for reading.