Minnesotans experienced adverse health outcomes due to delays in care, the use of telehealth has surged, the bottom lines of physician practices in Minnesota were hurt significantly during the first months of the COVD-19 pandemic, and doctors fear the next wave of the virus. These are a few of the key findings of a recent study commissioned by the MMA on the impact of the pandemic on physician practices.
The study, “Minnesota Physicians Respond to COVID-19,” is based on responses to two surveys – one sent to Minnesota physicians (the 641 responses represent a +/- 4 percent margin of error at 95 percent confidence interval) and one sent to medical practice administrators (92 responses). Surveys were completed between June 16 and July 13, 2020.
“Given how quickly the health care world is changing during this pandemic, we realize these results are just a point in time,” says MMA President Keith Stelter. “But they do confirm a lot of what we’ve been hearing anecdotally – even for patients without COVID-19, their health is suffering, the pandemic has accelerated use and acceptance of telehealth by both patients and physicians, and there are serious concerns about what happens with the next wave.”
More than 50 percent of physicians reported that their non-COVID patients experienced adverse outcomes due to care delays. Specifically, 19 percent of physician respondents reported that patients had delayed routine or preventive care, 17 percent of respondents said their patients feared seeking care because of potential exposure to the deadly virus, and 5 percent reported that care delays caused a patient death.
"Several elderly patients have put off their patient appointments and had significant worsening of their pain issues," said one responding physician. Another pointed out: "There are patients on clinical trials that are hesitant to come back for visits, so this is impacting clinical research."
“The results of this survey confirm our concerns regarding patients avoiding care because of their fear of the virus,” Stelter says. “It’s one of the main reasons we’ve continued to encourage Minnesotans to seek care during the pandemic as part of our Practice Good Health campaign.”
Telehealth use grows
Not surprisingly, the use of technology increased dramatically during the pandemic, the study found. In 2019, practice administrators reported that approximately 3 percent of patient encounters were conducted via telehealth including e-visits, phone, and video visits. Since March 2020, that number has increased to 28 percent, an increase of 833 percent.
Eighty-four percent of physicians reported that patients were satisfied or very satisfied with telehealth visits. A similar proportion of physicians (83 percent) said telehealth is meeting the care needs of their patients. “Telehealth is a lot like doing house calls,” commented one respondent. “I am a guest in their home and the patient is much more comfortable. I hear the sounds of their life.”
Nearly three-quarters of physicians said they think it is important to retain telehealth as a care delivery method, but changes are needed for that to continue. Seventy-eight percent reported uncertainty around ongoing reimbursement by insurers as a barrier to broader telehealth adoption and use. Another critical barrier to telehealth adoption is on the patient side – 73 percent of physician respondents noted that patient access to technology and patient access to broadband (60 percent) were moderate to significant barriers to broader telehealth use.
“We’re glad to see the expanded use of telehealth,” Stelter says. “However, not all patients can currently access it. Many Minnesotans don’t have access to broadband. Variation in technology platforms can also drive patient comfort and use. For telehealth to be truly helpful, everyone needs to have the ability to use it effectively. This is yet another example of the health care disparities that exist in Minnesota.”
The bottom line
The research found that, overall, medical practices saw professional service volume and revenue decline by more than 45 percent for the period March 16 to May 10, compared to the same period in 2019. Non-primary care single specialty practices were hit the hardest, reporting a 76 percent decrease in median volume and revenue.
The pandemic has affected earnings for both physicians and other health care workers. Ninety-one percent of physicians reported that they experienced reductions in their cash compensation and/or benefits. Ninety-six percent of organizations reported that they implemented reduced hours, furloughs/layoffs, terminations, and/or hiring freezes for non-physician staff.
The survey also found that a large percentage of medical practices accessed financial assistance, be it through federal sources or a private loan/grant. The most common assistance was the federal Paycheck Protection Program, which was used by 73 percent of organizations. “The PPP and provider relief programs significantly helped our clinic to weather the storm of COVID,” said one respondent. “If there is a second wave, we would need similar programs to withstand the financial impact.”
Although respondents say they expect business to increase during the second half of 2020, they do not expect it to match 2019 levels. Multispecialty practices are the most optimistic about cash flow improvements.
Fear of the next wave
Administrators and physicians alike said they are concerned about a second wave of COVID-19. Ninety percent of administrators and 81 percent of physicians said they were concerned about their organization’s ability to withstand a second wave of COVID-19. More than a third of administrators and physicians noted the need for additional financial support if the state faces a second wave of the pandemic. Twenty-one percent also said they were concerned about having enough PPE for a second wave.
More About the Study
For an infographic and complete study results, click here