Primary care practices across the country could be facing a $15 billion deficit because of wide-spread cancellations of in-person visits due to coronavirus, according to a study published by Health Affairs.

The journal's researchers estimate that over the 2020 calendar year, primary care practices are expected to lose $67,774 in gross revenue per full time physician. They added that the $15 billion figure could double if current telemedicine payment practices are discontinued.

"Although the health system generally and primary care practices specifically have rapidly pivoted to providing virtual care, including by telephone and video visits, the extent to which such visits are able to replace the revenue of in-person visits and support the existing staff of primary care practices is not known," the study noted.

Making matters more difficult is the lack of solid regulation governing reimbursement for remote medical visits. Since many small practices have not made significant investments in telemedicine, and since most practices lack the technical expertise to operate a telemedical system, many are conducting telephone appointments without the certainty of being paid, the study said, adding, however, that some private insurers and Medicare are reimbursing telephone visits retroactive to March 2020.

Because of the unpredictability of the pandemic's long term effects on the economy, the researchers called for the development of new mitigation strategies to help the primary care system weather future economic losses. According to the study, "relatively small capitated payments from payers, employers or government could be used to mitigate losses and to keep practices from closing."

Researchers stressed that primary care practices are the first line of defense for patient maladies, and a broken system would be disastrous across the board, particularly in the aftermath of the pandemic.

The system would be under tremendous strain to care for the 100 million adults with diabetes or pre-diabetes, hundreds of millions with obesity, and other conditions, the study said, noting that 60 percent of visits nationally for these chronic conditions are done in primary care medical practices.

"A health care system without the necessary primary care infrastructure therefore is likely to be increasingly fragmented, more costly, and less effective, and these costs will be borne by all Americans," the study said.

The study used a microsimulation model incorporating national data on primary care utilization, staffing, expenditures, and reimbursements, including telemedicine visits, to reach its results.

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U.S. primary care practices facing $15B hit due to COVID-19

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