Could Coronavirus put your doctor out of business? Some in Texas cut pay, staff
North Texas hospitals are readying themselves for a potential surge in novel coronavirus patients expected by June, but private practice physicians and specialists are facing a different challenge — a steep drop in patients and a decline in revenue that may force them to make hard decisions.
Fort Worth area doctors say they’re seeing as little as half as many patients as they did before the coronavirus, but Dr. David Fleeger, president of the Texas Medical Association, said the decline could be as high as 80% for some doctors. Fear of catching the virus has kept patients from visiting their primary care physician, and local and state mandates have shuttered many specialized practices.
Across the country as many as 60,000 family practices will close or reduce business by June, according to a HealthLandscape and American Academy of Family Physicians report. That would leave roughly 800,000 of their employees without work or on reduced hours and create doctor shortages in at least 750 counties. Tarrant County wouldn’t face a shortage, according to the report, but Parker and Johnson counties would.
That’s bad news for patients, said Fleeger, as the loss of private practice doctors now jeopardizes care in the long term.
“The question will become access,” he said. “Private practice doctors spread care out over a larger geography.”
While most health care workers may be able to find jobs with large hospital networks, that care is centered in major metros, typically at hospital hubs. Rural and suburban patients may find it hard to get to the doctor. About 10% of Texas doctors work for a hospital while 34% are self-employed, according to a recent Texas Medical Association survey.
While the Texas Medical Association didn’t have hard numbers, Fleeger said he’s heard from dozens of practices that have furloughed or laid off staff, including nurses and medical assistants. He suspected there were “thousands” of unemployed health care workers in Texas.
“It’s safe to say most practices in Texas are in the red right now,” Fleeger said. “There are practices whose viability is definitely in question if this continues.”
Fort Worth Physicians
Independent doctors in the Fort Worth area, like restaurant owners, are trying to pluck along without reducing staff.
Dr. Greg Phillips, who has an office in Fort Worth’s medical district and sees patients at two hospitals, would typically have around 25 patients a day in person before coronavirus. Now he sees less than 20, with many patient contacts done via a phone call or video chat.
With the drop in patients, Phillips has seen a decline in revenue, placing the possibility of furloughs or layoffs in the back of his mind. His office has six full-time employees between the office and medical staff.
Phillips hasn’t applied for federal or state relief programs, he said, because he believes he has enough money saved to float his practice for a little longer.
“Since I think I’m doing OK, I’ve left that alone for other businesses who might need it more than me,” he said. “I do catch myself checking my bank account more than I used to.”
Dr. Brian Byrd, who owns Texas Family Medicine, said his practice saw about 30% fewer patients in the last month than normal. Byrd is also a Fort Worth city councilman.
Byrd said his staff, accustomed to checking patients in and going over their paperwork, now spend most of their day teaching people how to use technology. The majority of his patients are older and less accustomed to video chat services like Zoom or Facetime
To cover the decline in revenue, Byrd and the three other physicians in the practice have taken pay cuts, he said. He also ended his own profit sharing and has applied for small business assistance available through the federal stimulus package for paycheck protection.
Like all businesses, doctors are operating with a lot of uncertainty about when it will be safe to have patients back in the office. The downturn in revenue and patient visits is likely to continue for months after the outbreak has ended.
“The city and county may say everyone is free to move around, but a lot of folks are going to say ‘Yeah I’m going to wait a month or two, especially when it comes to going the hospital,’” Byrd said. “That’s when it’ll become tricky.”
Telemedicine bills
Billing for telemedicine has been a point of confusion for doctors, both Phillips and Byrd said. Before the outbreak, insurance companies and Medicare paid doctors significantly less for a virtual appointment.
Byrd, for instance, said he is often paid $70 to $100 per visit, depending on the circumstances. Last week he received $4.50 in reimbursement for a virtual visit.
Medicare, Medicaid and insurance providers regulated under the Texas Department of Insurance have agreed to pay doctors the same for telemedicine as they would for an in-person visit. That covers less than 30% of insurance providers, Fleeger said. While some federally regulated insurance companies have agreed to pay the higher rate, not all have, creating uncertainty.
“There seems to be a real mixed bag,” he said.
Specialized care
Specialists are seeing some of the biggest reductions in patient volume, said Fleeger, who is a colon and rectal surgeon in Austin.
His practice has seen an 80% drop in patients he said. Anecdotally, he said he has heard through the Texas Medical Association about plastic surgeons, ophthalmologists and other specialists closing completely and laying off staff. One office in Austin cut more than 100 positions.
Fort Worth specialists are also taking a hit, said Dr. Melanie Lagomichos with HSC Obstetrics and Gynecology. Her practice has not been hit as hard as others, she said, because “thankfully people are still having babies.” But the office has seen a sharp drop.
Most OB/GYN’s need to see 20 to 30 patients a day to make a profit, Lagomichos said. She saw 10 patients on a recent Tuesday and made a few telemedicine calls.
The trouble is that many patients don’t know their regular physician or specialist is open, Lagomichos said.
“I think there’s an assumption we’re closed,” she said, noting that some patients have canceled appointments. “But there’s a lot we can do with telemedicine. I was a little surprised.”
