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The Milbank Memorial Fund is an endowed operating foundation that aims to improve population health by connecting leaders and decision makers with the best available evidence and experience. It does this work by:
The Milbank Memorial Fund is an endowed operating foundation that publishes The Milbank Quarterly, commissions projects, and convenes state health policy decision makers on issues they identify as important to population health.
August 3, 2020
Multipayer Primary Care Network Primary Care Transformation Primary Care Investment COVID-19
Melinda K. Abrams
Christopher F. Koller, President
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Primary care clinicians are critical to national efforts to contain, mitigate, and recover from the COVID-19 pandemic. Yet primary care practices nationwide are still in dire straits, with their ability to meet the needs of their patients and communities, or even stay in business, under threat. Unfortunately, the first three rounds of federal stimulus funding have ignored this reality by not providing any dedicated funding to primary care, putting us all at risk. The latest economic stimulus bill from the U.S. House of Representatives includes $100 billion for providers. As negotiations continue with the Senate and the Trump administration, explicit allocations to primary care should be made in the distribution of current provider relief funds and in any future stimulus packages.
The onset of the pandemic brought a precipitous drop in medical office visits. Although visits have rebounded, visits to adult primary care and pediatric practices were still lower than usual as of June 20. These lower volumes will likely persist and are having a cumulative effect on primary care clinicians. In a recent survey of primary care practices by the Larry Green Center, 20% of clinicians reported skipping or deferring their salaries in the last four weeks.
Our country needs strong primary care. Investing in primary care now will:
Future federal COVID-19 recovery and stimulus efforts—whether new funds or allocation of existing ones—should prioritize primary care practices, their workforce, and the patients they serve. To that end, Congress should keep the following three guidelines in mind:
First, lawmakers should provide targeted financial support for primary care clinicians. Primary care practices need more money now to stay afloat while office visits and revenues are down. In addition to paying for services provided, Medicare and Medicaid programs should make upfront, supplemental monthly payments to practices and not require the customary state contribution for Medicaid, because state budgets are so strained.
Priority should be given to rural primary care practices; small, independent practices (physician-owned with fewer than 250 physicians); those serving low-income communities; and those operating in areas with high rates of COVID-19.
Second, COVID-19 relief and recovery efforts should include funds to encourage the employment of essential health care workers in outpatient care settings. A diverse set of frontline community-based health care workers could help to assure the safe reopening of the economy, provided they receive additional financial support. These workers offer much-needed care to non-COVID-19 patients, enabling them to stay at home and avoid hospitalizations. They are also an effective force for COVID-19 testing follow-up and contact tracing.
For example, community health workers—trusted laypeople hired and trained to support patients—should be permitted to connect Medicaid enrollees with social services, such as nutritional services, and have it count as medical assistance since it confers direct health benefits for people with chronic diseases that have dietary restrictions, such as diabetes. Home health aides deserve increased compensation through Medicare and Medicaid, as well as personal protective equipment (PPE) to ensure their safety. Family caregivers, who assumed an increasing amount of responsibility during the pandemic, should be paid at rates consistent with professional home health aides.
Finally, all COVID-19 relief efforts should include funding and guidance to ensure widespread testing for COVID-19 through all outpatient care sites. All outpatient care practices—regardless of specialty—need sufficient equipment (testing kits, PPE) to safely conduct testing for the coronavirus to monitor spread and avoid future waves of pandemic.
“Each time history repeats itself, the price goes up,” said Canadian novelist Ronald Wright. We pay those costs in dollars and health. We should aspire to do more than just restore the health care system that left us ill-prepared for this pandemic. Through a targeted allocation of funds to primary care, Congress and the administration have the opportunity to bolster those working on the frontlines in our communities, which will help improve the nation’s health and prepare us for the future.
Melinda K. Abrams is senior vice president for Delivery System Reform and International Health Policy at the Commonwealth Fund.
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