Policy and Regulation

From continued telehealth reimbursement to more targeted federal relief, primary care practices need payment reform to survive the second year of the COVID-19 pandemic.

February 10, 2021 – Better-targeted federal relief, continued telehealth reimbursement, and help acquiring personal protective equipment are some ways primary care providers can maintain financial stability as the country enters the second year of the COVID-19 pandemic, industry experts are saying.

An already underfunded area of medicine, primary care has faced significant financial challenges throughout the first year of the pandemic, explained experts from the Robert Wood Johnson Foundation and Urban Institute in a new brief.

Funds from the federal government and telehealth reimbursement parity were key to surviving empty waiting rooms, higher PPE costs, and other changes in operations during the pandemic. However, experts found that policymakers still have much to learn from these sources of support.

“COVID-19 has created enormous challenges for primary care providers that could result in long term changes in the delivery of care,” Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, said in an emailed statement. “We need to find out what practices need to succeed in this environment, and devise policies to help support this foundational part of our health care system.”

The Provider Relief Fund, for example, did little to help independent primary care practices, the brief explained.

Established by the Coronavirus Aid, Relief and Economic Security (CARES) Act in March 2020, the Provider Relief Fund (PRF) has given hundreds of billions of dollars in grants to healthcare providers. But the government’s distribution methods have favored large hospitals and health systems, leaving most practices with relatively small payments from the initial, automatic distribution.

Instead, primary care practices relied more on Paycheck Protection Program funding and advanced Medicare reimbursements, the brief found. But again, hospitals received more upfront Medicare reimbursements, which were essentially zero-interest loans if repaid in time, compared to physicians.

“Future outlays from the PRF should ideally be better targeted than past payments, in order to support those providers most in need,” the brief stated.

Additionally, federal support is likely needed to ensure primary care practices can access sufficient PPE and meet the demand for increased telehealth and audio-only services.

The brief found that practices shifted rapidly to telehealth and other modes of care delivery when delivering in-person care was not feasible or safe, and that transition was relatively seamless according to the practice leaders interviewed for the brief.

But practices could not have been successful with telehealth implementation if not for federal support for reimbursement from the CARES Act.

“Respondents generally felt that their shift to telehealth as a significant portion of their interaction with patients was only viable because of altered payment rules and increased reimbursement for telehealth services,” the brief stated.

However, the reimbursement policies are only temporary and private payers who jumped on the bandwagon can pull the plug on telehealth reimbursement parity at any time in most states. Additionally, only one state has required payers to waive cost-sharing requirements for telehealth visits during the emergency period although many payers have elected to adopt the policy internally.

The latter policy has particularly supported practices, according to a Massachusetts respondent, who described deductibles as “killing” practices financially even before the pandemic.

Primary care practices are already planning the future of telehealth now that they have implemented the technology to facilitate visits and have a better understanding of how telehealth can fit into appropriate care delivery.

Patients have also taken to virtual care and many have started to demand telehealth appointments, even too much in some cases according to some practice leaders.

However, respondents reported that some private payers are already scaling back telehealth reimbursement rates and reinstating cost-sharing requirements. This is leading to concerns among practice leaders that telehealth will not be financially stable.

Practice leaders also voiced concerns about payers encouraging patient use of telehealth-only providers even though these providers may not be invested in the long-term health of a patient and can result in overutilization.

Continued support for telehealth reimbursement would help struggling practices maintain patient volumes in the event of more COVID-19 waves as well as with sustaining care transformations beyond the pandemic.

Additionally, policymakers should address increasing levels of clinician and staff burnout to strengthen primary care, experts stated.

These policy considerations could help to support vaccination efforts.

A new survey from the Primary Care Collaborative, Larry A. Green Center, and 3rd Conversation found that primary care continues to be untapped as the government struggles to administer COVID-19 vaccines. In fact, eight in ten primary care practice leaders surveyed said their organization is ready and willing to assist with vaccine distribution despite ongoing staffing shortages.

However, 44 percent of respondents also reported that local health systems are getting the vaccine, while smaller and independent practices are not.

“Primary care can play a major role in targeting and encouraging their patients to get vaccinated, particularly people with chronic conditions, the elderly, and people who are hesitant to get vaccinated,” Ann Greiner, President and CEO of the Primary Care Collaborative, said in an announcement. “Patients trust primary care, and trust is a major factor in our ability to help patients overcome vaccine concerns.”