NEW YORK (CBSNewYork) — The coronavirus pandemic has had a dramatic effect on health care in this country.
Perhaps the most serious impact has been on primary care doctors and clinics, many of whom are going closing up for good, CBS2’s Dr. Max Gomez reported Thursday.
Primary care is how chronic conditions like diabetes and congestive heart failure are managed, vaccinations are given, and cancer screenings are done. That’s why research shows that access to primary care translates into better health and health outcomes. Lost primary care means increased mortality, decreased quality of life, and, ultimately, much greater costs to the health care system.
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Dr. Michael Cascarina has a primary care practice in Brick, N.J. Like so many independent medical practices, Cascarina saw a disastrous drop in patient visits at the start of the pandemic. Telehealth video visits and phone consults have helped, but reimbursement for those is scheduled to end soon.
The drastic drop in revenue has Cascarina wondering whether his practice will survive.
“We go quarter to quarter. You know, in a good year, we’ll break even, or maybe be a little in the black. This year, I’m sure we’re going to lose money,” Cascarina said.
Cascarina is far from alone. A recent article in the New Yorker described a looming primary care crisis. Dr. Clifford Marks, an emergency medicine resident in the Mt. Sinai Health System, is the author.
“One of the issues that existed has existed in health care for a while, is that primary care has just been underfunded,” Marks said.
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The underfunding stems from the long standing medical reimbursement scheme which pays doctors for procedures, taking an x-ray, suturing a wound, or running blood tests. That fee-for-service approach reimburses little if any for the time-consuming, face-to-face counseling and education that is at the heart of chronic disease management.
Marks said one possible solution is called capitation.
“Pay per person per month or less so it would be ‘X’ dollars to cover someone for a year. And you pair it with some sort of quality measure,” Marks said.
Such a system would include Telehealth visits and reward doctors for keeping their patients healthy. Without some change in the system, many primary care doctors and clinics may soon disappear.
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