Survey Highlights How Independent Medical Practices Are Addressing the Pandemic and Planning for Future Practice Operations

There is still much to learn about COVID-19, including its impact on medical practices and their ability to rebound from dwindling patient volumes, according to a recent Kareo survey. The survey, which was conducted in late April, included 500 responses and focused primarily on independent, provider-owned medical practices in these specialties: primary care; mental health; physical, speech, and occupational therapy.   

For a visual representation of the Kareo survey results, you can see and download our related info-graphic here.

Notable Results 
Overall, Kareo’s research found that although providers are seeing fewer patients, many of them are simultaneously using telehealth to overcome challenges related to social distancing and stay-at-home orders, thus enabling patient access.

Practices that have remained open during the pandemic have seen an average 40% decrease in volume, the survey found. Among the hardest hit? Physical therapy clinics where the average patient volume decrease is more than 65%. Unfortunately, the timeline for returning to normal remains uncertain. Thirty-seven percent of practices reported they do not expect a recovery until sometime after June.

The good news is that relaxed regulations and an improved reimbursement landscape have enabled practices to implement telehealth, thus enhancing providers’ ability to render high-quality care while also remaining socially distant to prevent spread of the virus. Forty-eight percent of practices report using telehealth for the first time. This is in addition to the 25% of practices already using it. Seventy-two percent of respondents say they will continue to use telehealth post-pandemic.

Medical practice closures on the rise
Even despite the increased adoption of telehealth, weathering the storm of financial instability during COVID-19 been impossible for some practices. Approximately 20% of respondents reported complete closures of their medical practices—up from nine percent in late March. This is not necessarily surprising, given the difficulties that many providers experienced when trying to secure small business loans and obtain other financial assistance through the federal government. Although a second round of federal funds have been secured, questions remain about whether those funds will be able to sufficiently to carry practices through times of financial hardship for the unforeseeable future.

In addition, on April 26, Medicare announced it would discontinue its Advanced Payment Program that enabled providers to request an advanced payment of up to 100% of the Medicare payment amount based on a three-month lookback period. Providers were hoping these funds, which required repayment within 120 days, would help offset immediate financial losses.

Providers most and least affected by COVID-19
Given the impact of COVID-19 on everyone’s mental health, it is not surprising that patient volumes at mental health practices decreased by only 19% on average. This could be due to these providers’ immediate transition from in-person visits to telehealth. Sixty-five percent of respondents say their mental health practices are telehealth only, and 87% say they will continue to use telehealth in the future. Shifting to telehealth enables these providers to render uninterrupted mental health services during a time when those services are needed most. In contrast, physical, speech, and occupational therapists have seen a 67% decrease in patient volumes on average. This could be due to a slower telehealth adoption rate. One third of these providers say they offer in-office appointments only.

Interestingly, 42% of mental health providers anticipate being back to normal in May while only 19% of physical, speech, and occupational therapists feel the same way. This speaks to the ability of providers using telehealth to adapt more effectively to the new reality of COVID-19.

Recovery timeline remains unclear
In general, however, there is no consensus on when practices anticipate normal patient volumes will return. Roughly 33% of respondents say they expect patient volumes to recover in May while another 30% say it will not happen until the end of June with an equal percentage feeling that decreased volumes will continue well beyond that timeframe.

This uncertainty could be driven largely by looming unanswered questions about the availability of widespread testing and whether (and when) a vaccine will be deployed. In the meantime, practices continue to furlough employees, reduce staff hours, and cut expenses where possible.

Turning to telehealth during challenging times
By the end of April, 32% of practices that were still open had moved to care exclusively through telehealth while 17% only offered in-office care, and 51% offered both options. Fortunately, providers can use telehealth to render a whole host of services including new patient office visits, home visits, prolonged office visits, smoking and tobacco cessation counseling, annual depression and alcohol screenings, advanced care planning, and much more. Practices that use telehealth can offset some revenue loss while continuing to meet patients’ needs.

“It’s sobering to consider that 20% of the foundation of the U.S. healthcare system, the independent medical practice, have been taken offline by the pandemic,” said Dan Rodrigues, founder and CEO of Kareo. “But on a positive note, some healthcare professionals are starting to see the ‘light at the end of the tunnel’ while also deploying new technologies, like telehealth, to ensure care access during this time. Some of the changes made will benefit patients and practices long after this crisis ends.”

Still, questions about telehealth remain. Will private payers continue to cover telehealth in the long-term? Will Medicare once again impose originating site requirements? Will the agency renege its allowance of non-HIPAA compliant solutions such as the free version of Zoom, Skype, and Facetime? Thirty-three percent of respondents said they currently use non-HIPAA compliant solutions and would need to find a secure option moving forward if the regulations change.

Handling a surge if it should (will) come
When patients do eventually re-engage with their medical caregivers, 47% of respondents said they anticipate a surge in patient volume due to delayed care during the first few months of the pandemic. Although providers continue to promote preventive care such as annual physicals and routine screenings, many patients are afraid of exposure to COVID-19. This means routine care may not fully resume until patients’ concerns can be quelled. Practices will need to focus on increasing operational efficiencies to support an increased demand for services. This includes exploring telehealth solutions and redesigning care delivery workflows to identify which patients can be seen virtually versus which patients can be safely seen in person. It also includes exploring technological solutions that promote patient engagement and workflow automation. Practices that take the time now to explore options will be one step ahead.

For a visual representation of the Kareo survey results, you can see and download our related info-graphic here. Kareo has been committed to the success of independent medical and mental health practices for more than 15 years and wants to assist in every way possible to support these practices, especially during the 2020 pandemic. For additional resources to help during this challenging time, visit our COVID-19 resources page here.

About the Author

Lisa A. Eramo, BA, MA is a freelance writer specializing in health information management, medical coding, and regulatory topics. She began her healthcare career as a...

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