November 25, 2020
Results of New COVID-19 Practice Economic Impact Survey
Results from a new round of surveying make clear the coronavirus pandemic continues to adversely impact physician practices across Washington, threatening access to patient care in communities across the state. These new data points will be key to our advocacy efforts on behalf of physician practices in the weeks and months ahead.
In mid-October, the WSMA sent a new economic impact survey, the third since the start of the pandemic, to approximately 5,000 independent (non-networked) physician clinics in Washington state. The results from 71 physician practices demonstrate this critical health care setting is experiencing severe economic hardship while incurring thousands of dollars in costs due to the pandemic, including outlays for telemedicine equipment and software, increased costs for PPE, and interest on loans to try to keep their practices afloat.
Of survey respondents, 34% were solo practitioners, 40% were in practices of 2-10 physicians, and 11% were in practices of 11-20 physicians. Twelve percent of respondents represented practices of 21-100 physicians, and 3% of respondents were from practices with over 100 physicians. Most practices serve Medicaid patients (75%) and the uninsured (65%), in addition to commercial and Medicare patients.
Patient volume decrease compared to pre-pandemic
Of practices surveyed, 82% have seen a decrease in average weekly patient volume compared to average "pre-pandemic" weekly patient volumes in January.
Asked what percentage of typical revenue the patient volume decreases represent, practices answered:
- No decrease: 5% of practices
- Less than 10% decrease: 5% of practices
- 11-25% decrease: 46% of practices
- 26-50% decrease: 33% of practices
- 51-75% decrease: 10% of practices
Of practices surveyed, 28% have lost revenue up to $150,000; 42% have lost between $150,000 and $500,000; and 10% have lost over $1 million. These represent significant financial blows to practices already operating on thin margins.
For example, 69% of practices report having eight weeks or less "cash on hand," defined as the number of days a practice could pay its operating expenses with cash available. Ideally, practices should have 18 weeks' worth. 82% of practices indicated they would benefit from additional financial support.
As a result of the pandemic, practices have also taken on additional costs for personal protective equipment, screening supplies, and cleaning services/supplies:
- "800 percent increase in cost of gloves, masks, and other PPE."
- "Increased PPE, cleaning, and sanitizing supplies have cost an estimated additional $12,000; HVAC modification to improve filtration and ventilation cost $103,000."
- "Increased costs up to $10,000 for supplies."
Impact on community
The financial blow of COVID-19 extends far beyond the four walls of a physician practice, impacting the larger community in terms of reduced employment and access to healthcare services. Due to the reduction in patient volume, practices have reported taking the following measures:
- 60% have reduced office hours.
- 54% have implemented a temporary reduction in salary.
- 39% have laid off or furloughed staff.
- 24% have implemented a hiring freeze.
Personal protective equipment/testing
More than a third of practices (37%) are not able to source a continuous supply of PPE and 46% are not able to access test kits.
Numerous practices identified increased costs associated with PPE, both in terms of needing more supplies and those supplies coming at higher prices. This has led to the need for some practices to "aggressively reuse" PPE since the beginning of the pandemic.
Of practices surveyed, 85% are utilizing telehealth, with a majority of those have adopted telehealth during the pandemic.
In terms of telehealth modalities, 78% report using simultaneous audio/visual, roughly the same percentage are using audio-only telemedicine, and 29% are using e-visit platforms where patients initiate the visits using a patient portal.
Practices identified the following barriers to utilizing telehealth and/or increasing utilization, including:
- Costs with offering and maintaining a telehealth platform (29%)
- Issues with reimbursement from carriers (47%)
- Patient comfort using technology (60%)
- Patient broadband access (60%)
- Uncertainty about how telehealth regulation might change after the pandemic (64%)
WSMA practice advocacy
As we did with the results from our spring survey, the WSMA will use the new survey data to inform our advocacy on behalf of practices with legislators, media, and other policymakers in the weeks and months ahead. As our state "eventually moves from the combat zone to recovery," as WSMA CEO Jennifer Hanscom memorably described it, your support and engagement will be crucial. If you haven't yet renewed your membership for 2021, do so today.