Texas primary care doctors say they鈥檙e hemorrhaging cash and at risk of closing their doors during the coronavirus pandemic, and a new trade group proposal argues it鈥檚 time for Texas lawmakers to overhaul how physicians鈥� practices get paid.
More patients are forgoing office visits as they stay home to avoid the virus, and doctors鈥� offices report that their revenues have fallen sharply as a result. Many large health insurance companies have posted huge profits during the same period.
A family physician trade group wants insurers to share the wealth, and with four months before the 2021 legislative session is scheduled to begin, they鈥檙e asking state lawmakers for help. The Texas Academy of Family Physicians calls its proposal a 鈥淧rimary Care Marshall Plan,鈥� a reference to the massive program of U.S. investment to help parts of Europe rebuild after World War II.
鈥淛ust as the aftermath of war offers an opportunity to rebuild, the devastation COVID-19 wrought on our health care system and our economy gives us the opportunity to rebuild a better, more cost-effective system of care,鈥� the proposal says.
The physician group, which represents nearly 10,000 members, is also asking for other reforms, such as new state laws to make it easier for physicians to get paid for seeing patients via telemedicine. It鈥檚 calling on the Texas Legislature to expand the Medicaid public insurance program to cover poor adults, which would lower the state鈥檚 uniquely high uninsured rate and increase the number of paying customers at doctors鈥� offices. And it wants lawmakers to restore funding to a program that studied health disparities among racial groups until it was defunded in 2017.
But payment reform is their No. 1 demand, with the proposal calling for state-governed health plans to move away from the traditional 鈥渇ee-for-service鈥� payment model. Under that system, the mainstream in American medicine, physicians bill insurance companies based on each discrete service they provide, such as an office visit, lab test or immunization.
The doctors instead want insurance companies to embrace a 鈥減rospective payment鈥� model, in which insurers pay physicians a set fee per patient each month, akin to a subscription service.
Those changes are necessary to keep primary care physicians鈥� offices afloat, doctors say.
鈥淢ultiple insurers have made record profits, and their good fortune with corona[virus] is done on my back, in a sense,鈥� said Dr. Erica Swegler, a family physician in Austin.
The number of patients coming to Swegler鈥檚 office fell by more than half this spring during Gov. Greg Abbott鈥檚 stay-home order. Now she estimates she鈥檚 seeing somewhere between 70% and 80% of normal patient volumes. But many of those patients are opting for remote telemedicine visits, which Swegler says yield stingier payments from health insurers.
At the same time, some costs of doing business have grown during the pandemic, with items like gloves and masks demanding twice their pre-pandemic prices. As a cost-cutting measure, she said her office no longer carries a supply of vaccines on hand.
Swegler鈥檚 monthly revenue is down about $5,000 to $10,000 per month, which she says she has only been able to swallow by deferring loan payments, depleting a retirement fund and taking a pay cut.
鈥淲e are literally hanging in, so it鈥檚 a day-by-day, week-by-week thing,鈥� she said.
Some 8% of U.S. doctors reported shuttering their practices in the past four months because of the coronavirus, according to an August survey published by the nonprofit Physicians Foundation. More than 40% reported cutting staff.
Congressional bailouts such as Paycheck Protection Program loans have helped delay a spate of closures, doctors say, but those funds are drying up.
Dr. Christopher Crow, chief executive of the Catalyst Health Network, which includes nearly 1,000 primary care providers in North, Central and East Texas, said health insurers are warming up to the idea of prospective payments.
In the North Texas market, the physician network has agreements with two major insurers to enter such a payment arrangement, said Crow, who aims to sign with two more by 2022.
Virtually all of the network鈥檚 members have taken pay cuts this year, he said. If more primary care doctors go out of business, he said, more patients will miss out on preventive health care and end up receiving expensive emergency care later.
鈥淭he fact that we don鈥檛 supply good primary care means that we are taxing the citizens of Texas for more expensive health care in the future,鈥� he said. 鈥淚t is absolutely fiscally irresponsible, not to mention morally irresponsible.鈥�
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