Surviving COVID: How Physicians are Providing Vital Care and Keeping Practices Open
Patients often form strong and long-lasting bonds with their care providers and COVID-19 has drastically altered that ever-important doctor-patient relationship. Visits have moved online and fear of the virus has some patients skipping care altogether. This raises three concerning questions for physicians: how are patients with chronic diseases managing their treatment without regular in-person care; are patients putting their lives at risk unnecessarily by delaying care and screenings; and how will their practices survive through the pandemic so they can continue caring for their communities?
Dr. Susan Bailey, president of the American Medical Association, and a practicing allergist/immunologist, joined Chip to discuss how private physician practices have been handling COVID while caring for their patients and how Congress is helping.
Welcome to Hospitals In Focus from the Federation of American Hospitals. Here’s your host, Chip Kahn.
The COVID pandemic has dramatically affected the practice of medicine and the physician-patient relationship in this nation. In the past 12 months, many patients have chosen to see their doctors virtually, as statistics show, but many more are skipping necessary care altogether. With fewer seeking care, the resulting massive decline in patient visits challenges future access, as many practices are put in jeopardy. Now we are more than a year into the pandemic. And even though millions of vaccines are being distributed daily, in-person patient visits still are not back to pre-pandemic levels.
What does this mean for patients and the future of so many American physicians? Independent physician practices are at the cutting edge of care in the United States. Though at the same time, these practices are the most stressed by the COVID effect. In our episode today, Dr. Bailey is going to address the COVID effect on patient care and physician practices. Dr. Bailey is the President of the American Medical Association and in private practice with the Fort Worth Allergy and Asthma Associates for more than 30 years. Thank you so much for joining us today, Dr. Bailey.
Oh, thank you so much for having me, Chip.
Dr. Bailey, before we get started and get into the substance, will you tell us a bit about yourself, your practice, and your role as the President of the American Medical Association?
Sure. I did my undergraduate and medical school at Texas A&M University and did all of my post-graduate training at the Mayo Graduate School of Medicine in Rochester, general pediatrics, allergy, immunology, and then got back to Texas as fast as I could, and I’ve been in practice there ever since. It’s a small independent practice, three physicians, 10 people total in the practice, but I have been involved in organized medicine in one way or another ever since medical school, working my way up through my county medical society, and then the Texas Medical Association.
I was president there before becoming vice speaker, then speaker, and now president of the AMA. As AMA president, it’s my job to represent the organization to be the official spokesperson. Typically, the AMA president is on the road all the time, going to meetings and meeting with people, giving speeches. But of course, during the pandemic, my entire presidency has been virtual, but it’s still been busy and I still believe that I’ve been able to make a difference.
COVID has such an effect on all of our lives. What has been experience over the last year? How has it affected your patients, your practice, and your colleagues in private practice?
Well, my particular practice, I went to 100% telemedicine in a period of about two days a year ago. And granted, I am seeing more patients than I thought I would during my present year, because I haven’t been traveling. But it’s all been virtual. And for a while there, we weren’t seeing anybody because of local shutdowns and the fact that we didn’t have any PPE. That’s probably another podcast in and of itself, but it’s been incredibly challenging. The COVID-19 pandemic has really brought significant financial hardship to independent physician practices all over the country.
In-person patient visits to physician offices just plummeted last year, and physicians saw their revenue drop by an average of 32% according to a survey the AMA did last summer. If that’s the average, then you know that many physicians had much more than that. In fact, one in five physicians saw their revenue collapsed by 50% or more, and more than eight in 10 physicians say that their revenue still hasn’t recovered to pre-pandemic levels.
Most of the physicians I know are still not seeing the number of patients that they were before the pandemic despite vaccinations, despite PPE and social distancing and reconfiguring our offices to allow for safe care. The fact of the matter is there are still a lot of people that don’t feel comfortable going out to the doctor yet.
In this environment that you’re describing, how are physicians keeping the enterprise of practice upload for their patients, particularly with just this continuing uncertainty that COVID has caused?
It’s really been challenging, Chip. And of course, we understand that many patients stopped visiting, going into their doctors for routine care and for managing their chronic conditions. They only contacted their physicians if they felt like things were, were really urgent. I am concerned that this has another hidden tragedy in this pandemic of the tens of millions of people in our country that are battling one or more chronic diseases, which of course accounts for almost 90% of all the health spending in our country.
Chronic conditions like diabetes, asthma, hypertension really require a close partnership between a patient and physician. It requires regular monitoring, a defined course of treatment. And there’s lot of concern about many chronic diseases advancing in severity unnecessarily because patients haven’t gotten care they needed. The stakes for abandoning care are really high for communities of color.
Decades of mistrust, structural inequities, and even outright racism in and outside of our health system unfortunately have resulted in higher levels of heart disease, diabetes, obesity, and other chronic conditions that make these communities more vulnerable to COVID-19.
Unfortunately, continuing to postpone care will inevitably lead to a surge in hospitalizations for chronic conditions, pent up demand for screening exams and more so-called routine surgical procedures, and, unfortunately, put lives unnecessarily at risk even after the pandemic ends, and, of course, will further tax our health system that’s already been stretched impossibly thin with our pandemic response.
Dr. Bailey, you brought up the issue of PPE and reconfiguration. From a practical standpoint, how did you prepare your offices and your staff to care for patients with the difficult COVID safety requirements and what are other physicians doing?
Well, we had no significant PPE. We had gloves. Because to do allergy testing and give allergy injections, we use gloves. But the only masks that we had, we had an old box of 10 N95 masks that were leftover from the H1N1 pandemic 10 years ago that were sitting back on a shelf that somebody remembered. And as luck would have it, we have 10 people in our office. We had 10 masks, and we gave one to each person and told them to take very good care of it because it was a while before we were able to get anymore. It worked out okay because no patients were coming in.
We had to completely rework the flow of patients, screening them before they came into the office, taking temperatures, asking screening questions, moving all the chairs in the waiting room and then the examining rooms, and actually blocking off some of the examining rooms so that people could stay six feet apart. Hand sanitizer everywhere. And just the logistics of that work, it was doable, but it was pretty significant. But acquiring PPE has been a struggle for independent practices all over the country.
Even though many large health systems and academic medical centers had a well-defined supply chain and had existing contracts to get PPE, that didn’t mean that they shared them with physicians in practice, even if they happen to have privileges at that hospital. And of course, a two or three person office like mine couldn’t compete in the marketplace for scarce and expensive PPE. It was really a struggle. That was the right limiting factor for many practices being able to open up again.
At the end of the day, as we’ve sort of been discussing, everything in healthcare comes down to cost. In meeting the challenges caused by COVID, how well has the HHS provide a relief fund worked to mitigate the financial aspects of sustaining practices that we’ve been describing?
Oh, it’s been incredibly helpful. AMA’s own survey done last summer indicated that the majority of physicians who got Provider Relief Funding said it really made a difference for their practices. But recently, much of the relief in this fund has been much more targeted to rural health.
What could be done to improve the role of this funding? There’s still some left and Congress could act in the future. What would you like to see in terms of this funding from √?
Well, I guess, the ultimate goal would be for the fund not being needed at all anymore. But other than channeling more money to physician practices, we don’t really see much of a future of this funding when the pandemic ends.
Congress is extending the Medicare 2% sequester moratorium. How important is that action and how is it impacting the sustainability of practices?
Oh gosh. This is an issue that the AMA has taken very seriously. Because with all the hardships that we’ve been discussing, adding a 2% hit on top of that was just not going to be sustainable. Physicians have suffered so much. We were heroes a year ago and now they’re threatening to cut our pay. We’ve worked very hard and fortunately been successful behind the scenes to press on the House of Representatives and the Senate to reach an agreement that would eliminate this 2% pending cut.
The legislation that was passed actually yesterday by a vote of 90 to 2 will extend the existing Medicare sequester moratorium for nine more months through the end of this calendar year. And since it’s not the same bill the House passed, the House will get its chance to review and vote on the bill when they come back in April. We expect there will be significant bipartisan support to pass it. What about claims in the meantime? CMS has signaled that they intend to hold Medicare until April 14th to allow the time for the legislation to pass the House and be signed into law.
This is a really, really big win, and I think it shows that our message about physician hardships has been getting through to lawmakers, but we’re not done. Because of the most recent funding package that was passed, that unfortunately contained another 4% Medicare cut next year. That’s going to be the next step is to make sure that that doesn’t go into place, but with a 90 to 2 vote in the Senate, that tells me that there is really overwhelming support in Washington for physicians. We hope that we can make that a real thing by getting the sequester cuts removed at the end of the year.
We look forward to continuing to work with you on the sequester cuts, and I’m optimistic that we can avoid them into the future. Do you think Congress has done enough though during the pandemic to support clinicians and providers and particularly independent physician practices that are so important to patient access across the country?
There really is tremendous need in the physician community, and so there’s always room to do more. But we think that Congress is beginning to understand the pressure that physicians and our entire healthcare system and workforce have been under. We combined forces successfully with the American Hospital Association and the American Nursing Association to push Congress to pass about $180 billion to support frontline healthcare personnel last year. And we were able to secure many additional provisions to help those in private practice and other frontline caregivers at the present time.
We are very pleased about improvements to the Affordable Care Act that were included in the most recent COVID-19 Relief Bill, the American Rescue Plan of 2021, including the fact that individuals and families eligible for financial assistance to purchase coverage on the ACA marketplaces will get more help so that they’re better able to afford their premiums. The ACA’s so-called subsidy cliff has been eliminated, so there’s no longer an income ceiling that restricts eligibility to receive financial help with premiums under the ACA.
The AMA has long been in support of these improvement, and we really do think they should be made permanent to make sure our patients have ongoing access to affordable health insurance coverage.
Dr. Bailey, I so appreciate you taking time from your practice to speak with us today. I’m sure that our listeners will be very, very interested in our podcast. Where can our audience connect with you and the AMA online?
Well, first of all, thanks for having me. This has been a great conversation. You can always follow the AMA on Twitter with the @amermedicalassn, or you can follow me on Twitter @subailey, S-U-B-A-I-L-E-Y. And of course, you can find out lots more about the AMA or healthcare world and all the issues that are so important to physicians on the AMA website, ama-assn.org.
Great. We really appreciate it. Thanks a lot.
Great. Thank you.
Thanks for listening to Hospitals In Focus from the Federation of American Hospitals. Learn more at fah.org. Follow the Federation on social media @fahhospitals and follow chip @chipkahn. Please rate, review, and subscribe to Hospitals In Focus. Join us next time for more in-depth conversations with health care leaders.
Susan R. Bailey, MD, President, American Medical Association
Susan R. Bailey, MD, an allergist/immunologist from Fort Worth, Texas, was elected president of the American Medical Association in June 2020. Previously, she served as president-elect of the AMA for one year, speaker of the AMA House of Delegates for four years and as vice speaker for four years.
Dr. Bailey, who has been active in the AMA since medical school when she served as chair of the AMA Medical Student Section, has held numerous leadership positions with the AMA. These include serving as chair of both the Advisory Panel on Women in Medicine and the AMA Council on Medical Education, as well as representing the AMA on the Accreditation Council for Continuing Medical Education, the American Board of Medical Specialties and COLA.
Her long history of service in helping guide organized medicine extends to the local and state levels as well. She has served as board chair and president of the Tarrant County Medical Society, and as vice speaker, speaker and president of the Texas Medical Association.
Dr. Bailey is an allergist in private practice, and has been with Fort Worth Allergy and Asthma Associates for over 30 years. She completed her residency in general pediatrics and a fellowship in allergy/immunology at the Mayo Graduate School of Medicine in Rochester, Minn., and is board certified in allergy and immunology, and pediatrics and has been awarded the title of Distinguished Fellow of the American College of Allergy, Asthma and Immunology.
In addition to receiving her medical degree with honors from the Texas A&M University College of Medicine as a member of its charter class, Dr. Bailey was later appointed to the Texas A&M System Board of Regents by then Gov. George W. Bush, and has been named a Distinguished Alumnus of Texas A&M University and of Texas A&M University College of Medicine.
Dr. Bailey is married to W. Douglas Bailey, has two sons and one grandson, and is an elder and longtime choir member of her church.