Primary care practices across the U.S. could face a shortfall of $15 billion in 2020 due to the impact of the ongoing COVID-19 pandemic.

Such facilities are projected to lose more than $65,000 in revenue per full-time physician in 2020, following drastic declines in office visits and fees for services between March and May, says a new study conducted by researchers in the Blavatnik Institute at Harvard Medical School. They warn that these losses could substantially rise, should a second viral peak emerge later in the year, or if reimbursement rates for telehealth visits revert to pre-COVID levels.

"Practices have saved money by putting staff on furlough, but doing so may leave practices unable to care for their patients, especially in the context of pent-up demand for services and the ongoing pandemic," author Russell Phillips, director of the center and professor of global health and social medicine at HMS, told HCB News. "Practices also need help with the costs of PPE which is absolutely necessary to have, but expensive for individual practices to obtain at reasonable cost."

All specialties that rely on patient volume and cannot convert to telemedicine, fully or partially, to meet patient needs are suffering, especially in states where there is no parity for telemedicine and face-to-face visits. These include procedural specialties such as surgery and dermatology. Many, however, are in better financial positions than primary care to survive due to their finances often being in better shape compared to primary care practices, which usually barely break even year to year, according to Phillips.

The authors calculated projected financial losses on operating expenses and revenues by simulating the impact of the pandemic on a variety of practices. They analyzed both visit volume and visit type, along with other variables, and compared anticipated revenues, expenses and losses under several scenarios, including one in which a second shelter-in-place order was issued in November and December. They also reverted back provider reimbursement for telemedicine visits to significantly lower pre-pandemic levels.

Primary care in the U.S. is expected to be tasked with handling the worst parts of long-term COVID-19 care and management, testing, and vaccination once the virus subsides. The primary care system, therefore, must be able to meet the backlog of needs of the population, as well as resume care for major chronic medical conditions that together will affect the health of Americans for many years to come.

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