female doc, male nurse, patientPrimary care practices are the first line of defense for patientmaladies, and a broken system would be disastrous across the board.(Photo: Shutterstock)

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

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The journal's researchers estimate that over the 2020 calendaryear, primary care practices are expected to lose $67,774 in grossrevenue per full time physician. They added that the $15 billionfigure could double if current telemedicine payment practices arediscontinued.

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

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Related: Will COVID put primary care clinics out ofbusiness?

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Making matters more difficult is the lack of solid regulationgoverning reimbursement for remote medical visits. Since many smallpractices have not made significant investments in telemedicine,and since most practices lack the technical expertise to operate atelemedical system, many are conducting telephone appointmentswithout the certainty of being paid, the study said, adding,however, that some private insurers and Medicare are reimbursingtelephone visits retroactive to March 2020.

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Because of the unpredictability of the pandemic's long termeffects on the economy, the researchers called for the developmentof new mitigation strategies to help the primary care systemweather future economic losses. According to thestudy, "relatively small capitated payments from payers,employers or government could be used to mitigate losses and tokeep practices from closing."

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Researchers stressed that primary care practices are the firstline of defense for patient maladies, and a broken system would bedisastrous across the board, particularly in the aftermath of thepandemic.

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

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

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The study used a microsimulation model incorporating nationaldata on primary care utilization, staffing, expenditures, andreimbursements, including telemedicine visits, to reach itsresults.

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