For better or worse, experts say, changes in response to pandemic likely here to stay

to Medicare having made it easier for doctors to bill for virtual visits.

It’s easy to see why many patients like video visits — there’s no parking to find and pay for, and it takes far less time out of a workday than going to an office.

Doctors and other practitioners seem more ambivalent. On one hand, it can be harder to examine a patient over video and some services just can’t be done via a digital connection. On the other hand, they can see more patients in the same amount of time and may need less support staff and possibly smaller offices if more visits are conducted virtually.

Of course, telemedicine doesn’t work for everyone. Many areas and patients don’t have reliable or robust broadband connections that make video visits work. And some patients, particularly the oldest seniors, lack the technological skills needed to connect.

Primary care doctors in peril

Another trend that has suddenly accelerated is worry over the nation’s dwindling supply of primary care doctors. The exodus of practitioners performing primary care has been a concern over the past several years, as baby boomer doctors retire and others have grown weary of more and more bureaucracy from government and private payers. Having faced a difficult financial crisis during the pandemic, more family physicians may move into retirement or seek other professional options.

At the same time, fewer current medical students are choosing specialties in primary care.

“I’ve been trying to raise the alarm about the kind of perilous future of primary care,” said Farzad Mostashari, a top Health and Human Services Department official in the Obama administration. Mostashari runs Aledade, a company that helps primary care doctors make the transition from feefor-service medicine to new payment models.

The American Academy of Family Physicians reports that 70 percent of primary care physicians are reporting declines in patient volume of 50 percent or more since March, and 40 percent have laid off or furloughed staff. The AAFP has joined other primary care and insurance groups in asking the U.S. Department of Health and Human Services for an infusion of cash.

“This is absolutely essential to effectively treat patients today and to maintain their ongoing operations until we overcome this public health emergency,” the groups wrote.

One easy way to help keep primary care doctors afloat would be to pay them not according to what they do, but in a lump sum to keep patients healthy. This move from fee-for-service to what’s known as capitation or value-based care has unfolded gradually and was championed in the Affordable Care Act.

But some experts argue it needs to happen more quickly, and they predict that the coronavirus pandemic could finally mark the beginning of the end for doctors who still charge for each service individually.

Mostashari, who spends his time helping doctors make the transition, said in times like these, it would make more sense for primary care doctors to have “a steady monthly revenue stream, and (the doctor) can decide the best way to deliver that care. Unlimited texts, phone calls, video calls. The goal is to give you satisfactory outcomes and a great patient experience.”

Still, many physicians, particularly those in solo or small practices, worry about the potential financial risk, particularly the possibility of getting paid less if they don’t meet certain benchmarks that the doctors may not be able to directly control.

But with many practices now ground to a halt, or just starting to reopen, those physicians who get paid per patient rather than per service are in a much better position to stay afloat. That model may be gain traction as doctors ponder the next pandemic, or the next wave of this one.

Hospitals on the decline?

The pandemic also might lead to less emphasis on hospitalbased care. While hospitals in many parts of the country have obviously been full of very sick COVID-19 patients, they have closed down other nonemergency services to preserve supplies and resources to fight the pandemic. People with other ailments have stayed away even when services were available for fear of catching something worse than what they already have.

Many experts predict that care won’t just snap back when the current emergency wanes. Dr. Mark Smith, former president of the California Health Care Foundation, said among consumers, a switch has been flipped. “Overnight it seems we’ve gone from high-touch to no-touch.”

Which is not great for hospitals that have spent millions trying to attract patients to their labor-anddelivery units, orthopedic centers and other parts of the facility that once generated lots of income.

Even more concerning is that hospitals’ ability to weather the current financial shock varies widely. Those most in danger of closing are in rural and underserved areas, where patients could wind up with even less access to care that is scarce already.

All of which underscores the point that not all these changes will necessarily be good for the health system or society. Financial pressures could end up driving more consolidation, which could push up prices as large groups of hospitals and doctors gain more bargaining clout.

But the changes are definitely happening at a pace few have ever seen. Said Wilensky, “When you’re forced to find different ways of doing things and you find out they are easier and more efficient, it’s going to be hard to go back to the old way.”

Kaiser Health News is a nonprofit news service committed to in-depth coverage of health care policy and politics.

More providers are using telemedicine, and Medicare has made it easier to bill for virtual visits.