Post by Kim Yu, MD, FAAFP
Acute declines in revenue have meant practices, both in independent primary care and in employed models, have been seeking different sources of revenue. Many have applied for the various Small Business Administration (SBA) loans, Payment Protection Plan loans (PPP), Medicare advance payments and other loans. For those that received stimulus payments, those HHS direct deposits were truly welcome, given these uncertain times. Yet, these measures do not meet the needs of many in independent primary care, particularly those whose overheads exceed current revenue, and practices that fear closure or furloughs of staff at a time when manpower and staffing are at a premium, especially in California where there is already a primary care shortage.
These drastic reductions of revenue highlight the fact that in the United States, our fee for service structure is not built to stand for pandemics or disasters. It is critical to have a strong primary health care system in place. And yet because of the financial models in place, practices are facing staff furloughs, lay-offs and pay cuts. Many fear that they will not have enough cash within the next four weeks (see Larry Green Survey week 7 (7)). It is because of these tremendous financial difficulties that it imperative to speak up. I applaud the CAFP for highlighting the tremendous burdens many are facing and hope all will support the three legislative asks, see https://www.familydocs.org/news-we-need-all-family-physicians-to-act-now/. Without significant help, there will be catastrophic losses in primary care. We already have a crisis and shortage looming in California, and I fear many more will close their practices and leave the state, choosing states with lower costs of living and improved payor mixes. In addition, the cuts to the Song-Brown program will shrink the program by $33 million, more than 90% of its funding, drastically cutting primary care residencies. If there’s anything these COVID times have shown us, it is that a value-based care system would help protect family physician practices. Having payment for the prospective care of patients, for the care of populations, for improving the care of whole communities is possible, if primary care is reimbursed properly. I challenge those in power to make decisions for our state and nation thinking about how best to ensure primary care is shored up and protected against such catastrophic disasters in the future.