Telehealth Reimbursement Needed to Address Demand, Staffing Issues


About 41% of primary care clinicians say going back to pre-pandemic telehealth reimbursement rules would kill virtual care at their practices and exacerbate staffing issues.

The survey conducted in mid-August by the Larry A. Green Center, in collaboration with the Primary Care Collaborative (PCC), found that primary care practices have come to rely on telehealth. About 40 percent of primary care clinicians surveyed as part of the ongoing COVID-19 Primary Care Survey said that at least a fifth of all office visits are done through telemedicine.

Additionally, nearly two-thirds (64 percent) said telehealth has been integral to maintaining access to care.

However, 41 percent of survey respondents are worried that their practice will not be able to support telehealth/telemedicine services if pre-pandemic regulations are restored. Availability of telehealth reimbursement is a major concern with the regulations, with about a fifth (21 percent) of clinicians saying their practice has already had to pull back on the use of telehealth since payments were reduced.

Pandemic-related regulations have enabled telehealth by providing payment parity or, at least, higher reimbursement rates for telehealth services while the country navigates safely returning to in-person care in the midst of a global pandemic. The explosion of telehealth as a direct result of the regulations has led to some permanent changes to how public payers reimburse providers for telehealth. But many private payers have scaled back their pandemic-era telehealth reimbursement policies.

But telehealth reimbursement may be key to keeping up with increased patient demand for virtual services and addressing one of primary care’s biggest challenges during the pandemic: healthcare staffing.

“The potential loss of this adaptive tool is yet another challenge for an overstretched workforce in which more than half report mental exhaustion is a constant worry as both COVID-19 and patient needs surge,” authors of the survey stated.

“Seven in ten say patient visits now take more time, 65 [percent] say mental health concerns are increasing among children, and the majority are managing the care of people with long haul COVID-19, despite limited guidance on how to do so (58 [percent]).”

Clinicians themselves are also feeling the effects of treating more complex patient needs on top of COVID-19. Over half of survey respondents (52 percent) reported severe or near severe pandemic-related strain. This level was close to the ones measured by the survey from May/June 2020.

Furthermore, 45 percent of the respondents said they know a clinician who has retired early or quit. About 29 percent of respondents also know of a practice that has closed.

Finding qualified talent to alleviate staffing concerns is a major challenge. About 21 percent of clinicians said they are unable to hire other clinicians for open positions and 54 percent were unable to hire for open positions in general.

The issues may tie back to the financial health of primary care. Primary care practices took a $15 billion hit at the start of the COVID-19 pandemic in 2020, according to a study published in Health Affairs. The losses stemmed from dramatic declines in in-person visits when shelter-in-place orders were enacted.

Over a year into the pandemic, primary care practices are still feeling the financial consequences of treating patients during COVID-19. Nearly a third of respondents (32 percent) reported that their practice revenue has yet to recover. These respondents were also more likely to be from self-owned for small practices.

Additionally, less than 30 percent were able to say their practice was financially healthy.

“Primary care is resilient but has weakened,” the survey concluded. “Lack of decisive action and support for primary care continues to undermine its ability to meet growing population health needs and safeguard its workforce.”

“Public and private payers must continue to support use of telemedicine to maintain patient access and practice capacity for care delivery. Left with the most difficult to vaccinate portion of the population, primary care clinicians must be adequately supported for the resource and time intensive process of countering COVID-19 vaccine hesitancy.”

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