Drop in patients could shutter many independent clinics

Every flu season, Dr. Jeffrey Harris’s clinic in Newville, Cumberland County, is packed with patients. It was just as busy during outbreaks like the H1N1 scare in 2009. But the COVID-19 pandemic has been much different for the medical center, which is currently seeing less than half the patients it normally would.

Independent medical practices like Harris’s Graham Medical Clinic have overhauled how they offer in-person visits to protect their staff and patients from contacting COVID-19, but if patients don’t return soon to their providers, many small clinics – some say 30 to 50% — could face closures by the end of the summer.

“There is certainly anxiety among independent physicians and other specialties,” Harris said. “I never would have thought that a health crisis would bring our patient numbers this low.”

Dr. Nader Rahmanian, a Wyomissing, Berks County-based geriatric specialist, is seeing only 10% of his patients face-to-face.

Telehealth services have become much more profitable for health care providers in the past two months thanks to changes that the Centers for Medicare and Medicaid services made regarding how much Medicare pays for telehealth services during the pandemic. Still, telehealth’s expanded payout for Medicare patients, isn’t closing the gap because many of Rahmanian’s patients don’t have internet connections or phones to use the service.

For an independent clinic that relies on patient visits to get the most reimbursements possible from insurers, failing to get patients in the door will not only harm the patient but could be the end of the clinic.

“I need to bring them to the office or get them to the emergency room, but they are afraid to go anywhere,” Rahmanian said. “They don’t want to go to labs either because they are worried about exposure.”

At Jackson Siegelbaum Gastroenterology, which reopened its Camp Hill office this week, each of its provider teams are doing face-to-face visits with patients just one day a week, said Heather Nairn, COO at Jackson Siegelbaum.

The gastroenterology group also operates a surgery center in Camp hill and another office in Harrisburg, which is planned to reopen by the end of the month. When they open, there will be changes: checkpoints for staff to check the symptoms and temperatures of patients before they enter the building, and waiting rooms that have been redesigned to keep patients six feet apart.

Heather Nairn, COO at Jackson Siegelbaum, said that providers need to go above and beyond safety measures to demonstrate to staff that they are willing to do what it takes to keep them safe.

“If you are demonstrating to your staff that you want to protect them, they are going to take that and transmit it to your patients when they call them to schedule and when they see them in the office,” Nairn said. “That message goes through.”

Both Rahmanian and Harris are relying on federal assistance to keep their employees on staff and remain operational, but with experts predicting that the COVID-19 pandemic will last long into the year, small clinics without the backing of large health systems will need additional help. Loans such as the Patient Protection Program are keeping clinics open by providing money to pay staff, but in the coming months Rahmanian estimated that 30% to 50% of the state’s independent practices may have to close or furlough their businesses. Other practices may be able to survive by partnering with area health systems.

Third party payers have yet to offer the same reimbursements for telehealth services as Medicare, meaning that providers will need to stomach the lower reimbursements for care if they continue to offer telehealth.

Nairn said she would like to see further support from commercial payers as well as other vendors that work with health care providers to help these small businesses stay open and retain employees.

“This is the time that we need a call to action for everyone to focus on the philosophy of people over profits and let’s build some partnerships to get through this crisis,” she said.