COVID-19 Pandemic: Impacts on Primary Care Diane Rittenhouse, MD, - PowerPoint PPT Presentation

COVID-19 Pandemic: Impacts on Primary Care ⁄ Diane Rittenhouse, MD, MPH ⁄ Senior Fellow, Mathematica ⁄ Professor, University of California, San Francisco ⁄ DRittenhouse@mathematica-mpr.com ⁄ @dianerittenhous 1

Primary Care … in Crisis ⁄ Family Medicine, ⁄ Transformation for > 10 years General Internal Medicine, ⁄ Chronically under-resourced and General Pediatrics - Financial investment ⁄ First contact care - Fee-for-service payment ⁄ Relationship-centered - Human resources - workforce - Technical assistance ⁄ Foundation of high-quality, low-cost, equitable health care system 2

Ambulatory care visits, by age 10% 0% -10% -20% Ages 0 – 2 -30% Ages 3 – 5 Ages 6 – 17 -40% Ages 18 – 64 -50% Ages 65 – 74 -60% Age 75+ -70% -80% 1-Mar 8-Mar 3-May 12-Jul 19-Jul 26-Jul 16-Feb 23-Feb 15-Mar 22-Mar 29-Mar 5-Apr 12-Apr 19-Apr 26-Apr 10-May 17-May 24-May 31-May 7-Jun 14-Jun 21-Jun 28-Jun 5-Jul Data are presented as a percentage change in the number of visits of any type (in-person and telemedicine) in a given week from the baseline week (March 1 – 7). Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Changing Patterns of Care in the Newest COVID-19 Hot Spots (Commonwealth Fund, Aug. 2020). https://doi.org/10.26099/yaqe-q550 3

Routine childhood immunizations * VFC data represent the difference in cumulative doses of VFC-funded noninfluenza and measles-containing vaccines ordered by health care providers at weekly intervals between Jan 7 – Apr 21, 2019, and Jan 6 – Apr 19, 2020. US Department of Health and Human Services/Centers for Disease Control and Prevention MMWR / May 15, 2020 / Vol. 69 / No. 19 4

Telehealth visits 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% Data are presented as a percentage, with the numerator being the number of telemedicine visits in a given week and the denominator being the number of visits in the baseline week (March 1 – 7). Telemedicine includes both telephone and video visits. Source: Ateev Mehrotra et al., The Impact of the COVID-19 Pandemic on Outpatient Visits: Changing Patterns of Care in the Newest COVID-19 Hot Spots (Commonwealth Fund, Aug. 2020). https://doi.org/10.26099/yaqe-q550 5

Primary Care Providers Speak: ⁄ The "I can do 4-6 weeks of this" transition to "this feels like a new/permanent normal" is crushing and demoralizing. Ways to build morale when everyone is at a computer workstation away from other staff (and patients) feels impossible. (Ohio) ⁄ I am seeing a counselor regularly, and clearly have compassion fatigue. Pain from the daily treadmill, crying because of the broken system locally and fractured national disaster, knowing how different it could be. (Virginia) ⁄ March-June the stress level was constant and severe. I had a physical and emotional meltdown in June and had to take a week off. Emotional exhaustion has also been affected by a physician colleague's suicide in May. (Oregon) https://www.pcpcc.org/2020/07/14/primary-care-covid-19-week-16-survey 6

Primary Care - Moving Forward ⁄ Small independent primary care practice revenue needs to be stabilized ⁄ Primary Care investment needs to increase ⁄ Transition to population-based prospective payment (capitation) for primary care ⁄ Telehealth is here to stay – need to support with $ and TA ⁄ Primary care practices need both financial support and human support to continue to serve and continue to transform 7