The COVID-19 pandemic presents exceptional challenges to health care workers and the health system as a whole. It has strained the provider community and shined a bright light on the U.S. health care system — both its strengths and weaknesses. The fragility of the primary care payment system has been demonstrated while our primary care providers have shown unparalleled strength in the face of unprecedented challenges. This crisis has also laid bare the racial disparities that continue to persist across our nation. PCDC believes a strong primary care infrastructure is a necessary first step towards reckoning with the stark reality we face today. We believe the pandemic presents an opportunity for meaningful policy change. A health system rooted in primary care, with highly functioning hospitals and close collaborations with public health, will strengthen our country’s ability to address and manage future threats and achieve health equity. Through advocacy, investment, and quality transformation, PCDC is committed to helping create the system we need.
COVID-19 Policy Issues
PROMOTE PRIMARY CARE UTILIZATION
Use outreach and education to promote utilization of primary care to maintain prevention and management of chronic conditions.
Many individuals in communities with disproportionate rates of chronic disease have delayed or foregone their care during the pandemic, putting them at high risk for COVID-19 complications as well as long-term health effects resulting from lack of care management. Health disparities will only widen in the coming months as we face the possibility of a “second pandemic” resulting from deferred care without management and treatment of chronic disease by primary care providers.
Preventing and managing chronic conditions is what primary care is set up to do best. Primary care is often the first point of contact with the health care system and can prevent, identify, and treat illnesses as well as promote wellness. Primary care physicians build trusted relationships with patients over time which allows them to deliver care in a culturally competent manner, taking into consideration the social and cultural factors that impact their health. This is especially true in underserved minority communities where community-based primary care providers can provide a trusted source of support in a system that has historically left vulnerable patients behind. Governments must use all available channels to reduce barriers to utilization by communities of primary care, during the COVID-19 pandemic and beyond.
IMPLEMENT PROSPECTIVE PAYMENTS ACROSS ALL PAYERS
Require up front payment to providers across all payers.
This crisis has laid bare the fact that the fee-for-service (FFS) payment model is not sustainable for primary care providers in the face of a public health emergency. FFS models do not protect essential providers from financial threats and sets them up for failure during emergencies. The sustained and drastic decline in patient visit revenue has left primary care providers financially drained and has threatened their long-term sustainability to operate after the COVID-19 pandemic subsides.
Many states have worked over the last several years to advance payment structures based in value. This is more crucial now than ever before. Federal and state governments must move to implement prospective payments to providers across all payers. This fundamental change will provide immediate economic relief to primary care practices to enable them to re-open successfully and continue to give crucial care. Prospective payments will also sustain primary care providers in the face of a potential second or continued outbreak of COVID-19.
DESIGNATE MORE FEDERAL AID FOR PRIMARY CARE
Include designated funds for primary care providers in federal stimulus.
Primary care practices are suffering severe economic loss due to the sudden and sustained reduction of patient volume. Primary care practices have been forced to lay off or furlough employees to prevent shutting down completely. This is not sustainable. Primary care practices need immediate relief, or we risk losing many practices permanently thus putting patient lives at risk.
The federal stimulus bills to date have provided relief funds for hospitals and healthcare providers on the frontlines fighting the coronavirus. However, we cannot assume that the federal assistance thus far has reached primary care providers who need it as trickledown reimbursement rarely makes it to the target. In this crisis, many of the emergency payments have been tied to previous Medicare reimbursement – a metric that leaves out the providers who see Medicaid patients, which covers the most vulnerable Americans. Instead, funds must be specifically designated for the purpose of protecting primary care, particularly in poor and minority communities. Allocating federal aid directly to primary care practices can ensure they survive the sudden and significant loss of revenue resulting from deferred patient care and can continue providing essential services.
PROMOTE PUBLIC-PRIVATE PARTNERSHIPS
Convene public-private partnerships to deploy capital loans and grants to communities that need it most.
We were heartened to see that the HEROES Act passed by the US House of Representatives in May includes a $1B appropriation to the CDFI Fund (the Fund) for a rapid emergency grant program, and an additional $2B to the Fund, of which $800 million would be set aside for minority-owned lenders to support minority-owned businesses and their communities. We urge the US Senate to pass this Act and provide much needed relief for our communities.
But while the designated funds in the HEROES Act is a step in the right direction, this financial lifeline will be insufficient to revitalize many communities in a meaningful way. To fix this, state governments should follow suit and create capital funds using public, private, and philanthropic monies to deploy to underserved communities to enhance existing health facilities and increase access. This increased aid will ensure that minority communities decimated from this pandemic are uplifted, enabling them to continue to expand and operate health facilities and other essential community services in low-income communities. This will help to facilitate sustained access to primary care for vulnerable populations who need it the most.
MAINTAIN TELEHEALTH REGULATORY FLEXIBILITY
Make telehealth payment parity and regulatory flexibility permanent.
Robust telehealth is crucially important as primary care providers continue to fight the current pandemic but will also be necessary in preparing for a second wave of infections and care delivery in the future. Telehealth use is not only important for continuing to ensure regular, safe access to care through COVID-19 but is beneficial to elderly, disabled, and geographically remote patients even outside of the context of the pandemic. Ensuring a strong telehealth infrastructure also includes improving and expanding broadband.
Telemedicine has been an important financial lifeline for primary care practices during the pandemic as in-person visit rates dropped drastically. Payment for audio-only visits have been important for practices seeing mostly elderly and underserved patients. Many of these patients have access to phones but not video-enabled telehealth apps. Strong telehealth (including telephonic care) payment and regulatory flexibility will create security for primary care providers and will not only prepare the sector for future crises but increase access for those communities most limited in their ability to see providers in person.
INVEST IN PRIMARY CARE
Rebalance health care spending by defining, measuring, and increasing investment in primary care.
There is near universal consensus that consistent primary care is crucially important to preventing chronic illnesses and creating healthy, thriving communities. Evidence shows that an increase of just one primary care provider per 10,000 people can generate 5.5 percent fewer hospital visits, 11 percent fewer emergency department visits, and 7 percent fewer surgeries. However, primary care has historically been undervalued and underinvested. It is estimated that as little as 5-7 percent of U.S. health care costs go toward primary care. The lack of investment into primary care has led to significant consequences for the health of Americans, including mounting rates of chronic disease and vulnerability to threats such as COVID-19. This is particularly true in low-income and minority communities, where access to a primary care provider remains a challenge. Effective investment supports more than just traditional primary care; it covers integrated behavioral and public health, care coordination, care transitions, and efforts to address social determinants of health. The pathway to recovery from COVID-19 is through increased investments in primary care in order to strengthen the system’s ability to keep us healthy.
PCDC is committed to supporting the primary care sector throughout the duration of the COVID-19 public health emergency to ensure the health and vitality of our communities. We have created a variety of resources for health care providers to aid them during this unprecedented time including a COVID-19 Capital Fund for community health centers, telemedicine technical assistance, a town hall on the impact of the pandemic on providers across the country, and a policy web series providing insights and recommendations for how primary care can sustain essential services during the pandemic and beyond.