Survey: Primary Care Practices Find High Stress is New Normal

The Primary Care Collaborative (PCC), in partnership with The Larry A. Green Center, today released results of a real-time survey of primary care clinicians conducted April 3-6, measuring the impact of COVID-19 on their practices.
 
This is the fourth consecutive week the organizations have conducted the survey as the number of cases of COVID-19 in the U.S. increases. 54% reported in the survey that mental health is an area of growing need for patients, and 72% reported that at least some of their patients have no ability to receive care through telehealth. This week’s survey results also show that the new normal for primary care practices is a stressful way of operating, with limited personal protective equipment (58%) and testing, nearly half with staff illnesses/quarantined, and financial uncertainty.
 
“Many of the challenges seen in earlier weeks of the survey persist. For example, many clinicians are reporting – about 60% this week – that they are not sure that the majority of the care they are providing is reimbursable,” said Rebecca Etz, PhD, Co-Director of The Larry A. Green Center and Associate Professor of Family Medicine and Population Health at Virginia Commonwealth University. “There is a moving silent heroism that, even with the uncertainty about payment, clinicians continue to do what’s necessary to meet the needs of their patients.”
 
"We join many other primary care leaders in calling for all payers to follow Medicare’s lead by reimbursing telehealth and telephonic visits at the same rate as face-to-face visits in order to meet patient need and protect healthcare staff,” said Ann Greiner, President and CEO of the Primary Care Collaborative. “We are also calling for a well-resourced national effort to get more diagnostic tests and personal protective equipment to practices. The current de-centralized approach is not working.”
 
This week’s survey results reflect input from over 1,000 primary care physicians, nurse practitioners, and PAs. Respondents spanned 49 states, Washington, D.C., and Puerto Rico, with the largest percentage of respondents (27.6%) from Washington state. Respondents’ specialties ranged among family medicine (71%), pediatrics (11%), internal medicine (8%), geriatrics (6%), and primary care pharmacy (1%). A third of responding clinicians work in practices where half or more of the patient population is covered by Medicaid, and about a fifth (22%) work in rural practices. Payment types varied: a third reported that the majority of their practices’ office visits last week were fee-for-service; 12% reported that the majority were capitated (excludes those that marked “unsure”).
 
Topline analyses include:

• Nearly three-quarters of respondents report patients’ inability to use telehealth as a stress on their practice.
  72% of surveyed clinicians say that they have patients who are unable to access telehealth due to no computer/internet.
• Patient mental health is being recognized as a critical need.
  54% report that COVID-19 has led to increased numbers of patients with mental or emotional health needs. The vast majority of surveyed clinicians report that evaluating patients’ psychological/emotional concerns as either a high (30%) or moderate (50%) priority for patient care.
• The primary care workforce is being redeployed to new roles.
  Over half of respondents report that redeploying clinicians or staff to new roles within the practice as a high (28%) or moderate (30%) priority for patient care. Redeploying them to other parts of the health system was also a priority, but to a lesser extent: 17% high priority; 23% moderate.
• Over a quarter (29%) of clinicians work at practices with NO capacity to test for COVID-19.
  Another 39% can test for the virus only according to CDC guidelines/restrictions. Only 3% can test for any reason
• Despite increasing billing flexibilities, primary care is facing payment challenges.
  Only 54% of respondents say that the majority (>50%) of their office contacts last week were reimbursable (excludes those that marked “unsure”).
• COVID-19 screening and care continues to hamper other primary care services.
  90% of those surveyed report limited well and chronic visits as a stress on their practice; 58% report that they have too few sick visits available for patients. Only 7% report “scheduling preventive visits” as a high priority in the past week.
• Adequate personal protective equipment remains a critical obstacle for primary care staff.
  58% report the use of used and homemade PPE at their practice.
• The pandemic continues to place high levels of strain on primary care practices.
  Just under half (49%) of respondents report that the current status of COVID-19 is having a “severe” impact (level 5 on a 5-point scale) on their practice. This is up from 44% the week before.

Visit PCC’s website for:

• Executive summary of the survey
• Full details of the survey
• Charts

Experts are available to provide insight and comment on the survey: 

• Ann Greiner, MCP, President & Chief Executive Officer, Primary Care Collaborative
• Rebecca S. Etz, PhD, Co-Director of The Larry A. Green Center and Associate Professor of Family Medicine and Population Health at Virginia Commonwealth University

If you would like to speak with either of these experts, please contact:

Stephen Padre
Communications Manager, Primary Care Collaborative
spadre@thepcc.org
202-417-3911

This survey is conducted weekly, and results are reported on the Larry A. Green Center and PCC websites.