When Todd J. Malteser, DO, closed his neurological clinic in March, He estimated that the income from telemedicine appointments would be sufficient for 3 months.

It was not.

“The income from telemedicine would not have been enough,” said Malteser MedPage today. “I only survived with the loans and grants.”

Maltese, who runs a neurology and sleep medicine clinic on Long Island, New York, reopened his practice on May 18 and is currently around 50% busy. While his practice has migrated to telemedicine relatively smoothly, he primarily treats headache sufferers, many of whom require injections, which, along with other procedures, make up the bulk of the clinic’s revenue.

He estimated his sales fell 75 to 85% in the two months his office was closed when he only treated patients through telemedicine. If he had no aid from Medicare advances and the Paycheck Protection Program (PPP), it would not have been sustainable, he said.

But providers who have not drawn any funds through the PPP or whose main source of income comes from electoral processes in a fee model run the risk of closing their doors for good as emergency measures to contain the spread of the coronavirus pandemic seep away in the summer.

“We survived those months and are now open again, but many practices may not have made it or are having problems,” said Malteser.

Nationally, outpatient visits began to recover in April after a decline of nearly 60%, but they are still about 30% lower than before the pandemic, according to a Commonwealth Fund Analysis of data from Phreesia, a planning service provider. In line with trends over the past few months, surgical and procedural specialties such as orthopedics and ophthalmology and pediatrics continue to decline, while behavioral health and certain other areas have begun to improve, according to the report.

“Even with the recent rebound and the surge in telemedicine payments, practices facing large lost revenue will struggle to continue to provide care,” noted Eric Schneider, MD, of the Commonwealth Fund. “Many will have no choice but to cut staff and operations when services are needed most.”

In April alone, more than 1.4 million healthcare workers lost their jobs, Dentists, doctors, chiropractors, and other ambulance workers account for nearly 80% of losses, according to the Bureau of Labor Statistics. In one nationwide survey of more than 700 medical assistants, 22.1% said they were on leave and 3.7% were permanently laid off due to COVID-19.

Many practice owners, like the Maltese, cut their own salaries to avoid layoffs.

“As we reopen, the volume will not come close to what we would have had in a normal week or month,” Maltese said. “That will be a challenge going forward, keeping the volume we need to pay the staff and everything else.”

At Maltese’s clinic, headache sufferers who had not received injections for two months filled his schedule the first week they reopened, but patient volume had decreased to about 70% the following week and continued to decline as the corn wore on back to about half.

“Just as emergency rooms are less voluminous, so is outpatient surgery,” said Maltese. “People don’t want to go [their homes]. “

In a survey by the Kaiser Family Foundation released May 27, 48% of adults said they or someone in their household said they were postponed or skipped medical care due to the coronavirus outbreak, and 11% said their condition had worsened as a result of delaying or canceling treatment.

In certain specialties, including primary care, these numbers are even higher. On May 1, 70% of GPs said their Patient volume had decreased according to a survey by the Larry A. Green Center in collaboration with the Primary Care Collaborative by at least half compared to pre-COVID-19 levels. As of May 22, 84% of primary care physicians reported that patients are still independently postponing their visits.

These trends can not only be observed in disciplines that provide routine or preventive care. In a survey of cancer patients published May 14 by the American Cancer Society’s Cancer Action Network, 79% said they did Delay in active treatment and 17% said they had postponed treatments such as chemotherapy or radiation.

“Cancer doesn’t stop with COVID-19,” said Ted Okon, executive director of the Community Oncology Alliance, which includes 950 community cancer clinics and is based in Washington, DC, “You need to get these patients treated.”

Okon’s network has been able to maintain care for most patients throughout the pandemic, implement telemedicine where possible, and avoid inpatient visits, Okon said. However, he is concerned that delays in mammograms, colonoscopies, and other screenings will lead to an increase in new patients in the coming months.

“Over time, more patients will come undiagnosed, who may be sicker and have more advanced disease because they postponed the diagnostic process that they would have previously had,” Okon said MedPage today.

In pediatrics, Vaccinations have dropped Stay-at-home measures have been in place in all states since mid-March, an indication that parents are delaying visits to wealthy children.

In primary care, many physicians struggled with proper personal protective equipment during the first few months of the pandemic, and the number of patient visits was compounded by the illness of staff, said Gary LeRoy, MD, president of the American Academy of Family Physicians.

“That got worse as the crisis progressed because, along with staff shortages and cash flow issues, you had these mandatory reductions in our wellness and chronic visits,” LeRoy said MedPage today. “The biggest challenge facing basic services is the financial challenge of staying afloat.”

In the primary care survey, only 38% of practices received PPP funding and 12% said they had another loan from Small Business Administration as of May 22nd.

The distribution of the Coronavirus Aid, Relief, and Economic Security (CARES) Act funds disproportionately favored doctors who mainly care for Medicare patients, according to a Letter to Health and Welfare Minister Alex Azar by professional associations representing gynecologists, paediatricians and general practitioners who complained that their members have been left behind.

“The situation for the front line doctors is dire,” the letter said. “[We] are facing dramatic financial challenges that lead to significant layoffs and even practice closings. “

In the primary care survey, more than 500 respondents (19%) said they had temporarily closed their practices, and 18 (0.6%) said they had closed them permanently as of May 11th.

“We do not have the financial support necessary to continue beyond this reopening,” said LeRoy. “The effects will continue into the third and fourth quarters. We still have to bring back employees who are on leave. ” [and pay] the overheads and bills that have been deferred. “

In view of the current economic hardship, there is a threat of a second wave of infections that would bring many clinics back to their starting point.

“We’ll be fine in the future provided there isn’t another wave,” said Maltese. “That will shut us down again. This is the wild card everyone is worried about. “

Last updated on June 3rd, 2020