Primary Care Collapse Impacts More than Rural Populations

Our nation likes to brand people and populations. This can be done by race or ethnicity or origin. It is popular to divide into rural vs urban in studies of health care. Articles, blogs, and other media sources make more dollars from advertising when they have divisive articles. Rural vs urban sells. Even worse, most of the US population is falling behind, but the focus is placed on rural or minority. Unfortunately this tends to minimize the proportion of the US population that is behind.

Consider that those falling behind are a majority and are increasing fastest in numbers, demand for health care, and in complexity. Consider that their local generalist and general specialist workforce is shrinking, now more rapidly than before.

Primary Care Finances are Broke, Broke, Broke

Primary care runs on about $500,000 to $600,000 per primary care physician. The lower revenue figure is more likely where care is most needed. This figure is more likely because these places are where practices most depend upon Medicare, Medicaid, and the worst private health plans. This is where Medicare plans pay 15% lower for the same office service. As other sources of revenue have dried up, office services are more important.

It gets worse in recent years.

• Revenue has not changed much since 2008. Cost cutting has dominated public and private insurance plans. It has also been more difficult to receive revenue with changes in coding, regulations, denials, delays, etc.
• Regulations and innovations now distract team members, resulting in declines in revenue.
• Costs of delivery have gone up by over $100,000 over the last decade just to keep the office open and another $100,000 in costs of delivery have been added for HITECH to MACRA to PCMH.

Rural Impact Are Significant

Rural practices tend to be smaller, independent, office based, and lower in revenue generation. The costs of delivery have often increased faster per physician because of the smaller size of the practice and relatively higher costs for innovation, regulation, and digitalization when small.

But Rural Is Too Small for Major Headlines Because So Much More of Primary Care Has Been Impacted

Rural areas are smaller parts of the nation and the rural population behind in local workforce is even smaller - at 12% of the US population. About 25% of the rural population enjoys local workforce that has a much better financial design and higher levels of workforce.

Rural is not specific to lesser workforce. Also rural and urban populations have been suffering.

Why not examine the situation facing 40% of the US?

Primary care in 2621 counties lowest in health care workforce with 40% of the US population had 38 billion to invest in primary care in 2008 or about 1 billion per each single

Revenue has not increased and it takes about 1 billion more a year for usual office costs and 1 billion more a year for innovative and regulatory costs. This leaves at least 1.5 billion less each year because of subtractions not covered by additional revenue.

It Gets Worse

This population has increased from 40% to about 43% of the US population. Increasing populations and decreasing finances results in growing deficits of access. Only about 26 to 30 billion remains where 38 billion once could be invested in primary care delivery.

The billions available to invest in primary care delivery are decreasing and the populations are increasing - along with greater demand and higher complexity.

Productivity losses from workforce impairment by design - have also decreased revenue. Local populations have also had to finance health insurance, decreasing what they have for other expenditures including primary care. Obamacare has made the situations worse in multiple ways.

Additional financial problems have been introduced by lower collection rates, value based care costs, and increased costs for updated software and security.

The math adds up to fewer and lesser team members, declining access where most needed, and closures of substantially more practices.

Enter COVID 19

COVID has trounced primary care with a recent loss of 40% of revenue. The practices impacted have been least likely to turn to government just as they have failed to implement the costly requirements and the complicated codes to increase payments.

Telehealth diverts more and more patients. Practices cannot afford more and better team members. The designs shape team members to fewer and lesser.

Bailouts Help the Few Doing Well and Fail for Those in Most Need

The theme is obvious. Corporations and larger entities have receive more billions. People, populations, and smaller entities get much less and what they can receive is difficult to obtain or limited in amount.