The End of Medical Groups

It seems like forever ago, but it’s only been two months since the first case of the Corona virus was diagnosed in this country.  Just two months later our reality has changed, maybe forever.  In just two months we have seen the stock market lose a third of its value, our government flush an unprecedented $2 trillion dollars of into the economy to keep it on life support and in just one week we watched 3.2 million American’s lose their job.  As if that weren’t enough, we now have news channels with total case numbers and death counts constantly displayed like some morbid ticker tape.  Any single one of these developments by itself is terrible, put together they are staggering.


In this new reality we do see small visions of hope and promise.  We see people coming together and trying to support one another.  We see teachers reaching out to their students in new ways and people putting in long hours trying to keep our grocery stores open.  Example after example of American’s stepping up and doing whatever it takes to help out.


One of the biggest examples of people doing the right thing in this time of crisis are our health care workers.  Doctors, nurses, and administrative personnel all putting themselves in danger of infection to make sure they are available to not only treat those with the virus but also everyone else with their illnesses or diseases.  Let’s remember that during this crisis MS didn’t take a day off, cardiac disease and cancer didn’t hit the pause button.  So, while we scramble to find ventilators and PPEs to treat those that are infected with Covid-19 our health care professionals continue to provide incredible care to everyone else as well.  For them, shelter in place and social distancing simply isn’t an option.


I am encouraged every time I see someone say “thank you” to these individuals on social media.  It makes me happy when people who used to take our health care delivery system for granted suddenly develop a newfound appreciation for these dedicated professionals.  Let me pause here and add my personal thank you.  Thank you to ever doctor, nurse, administrator and non-clinical personnel.  Thank you for what you are doing now and what you do every day.


What most people don’t understand and hasn’t been reported much is that these wonderful people are being hurt financially right now.  We understand the financial impact this crisis is having on the travel industry and the restaurant industry, but most people don’t understand what is happening to physician practices during this crisis.


With the exception of Emergency Physicians almost every other physician group and specialty is experiencing a significant and almost immediate reduction in revenue due to reductions in patient volumes.  Elective surgeries are being canceled.  Preventative medicine services like mammography and colonoscopy are being put off.  Patient visits are down as people are choosing to stay home out of fear of infection.  Across the country physicians are spending their time caring for their patients while at the same time struggling to figure out how they keep their employees and pay the bills when the revenue is cut off.  I have talked to way too many physicians who have told me that they are not taking any paycheck and don’t think they will for the next two months at least so that they can pay their nurses and staff.  That’s right, not only are they putting themselves at risk of infection to keep the rest of us well, they are doing it in some cases without any pay.


As if that were not bad enough, it appears that there is going to be a winner as a result of this crisis.  That’s right, there is one industry not named Amazon that is likely to profit significantly from all of this.  The big winners in all of this may be the health insurance companies.  You see, when doctors talk about revenue reductions caused by Covid-19 that means that somewhere there is an insurance company that is experiencing an expense reduction.  All of those health care services not being done mean claims and bills not being paid by insurance companies.  Those insurance companies are still collecting the full health care premiums they just aren’t paying out as much money in claims.  This comes at a time when insurance companies are making record profits.


Take United HealthCare as an example.  Recently UHC released its earnings for 2019.  The company reported that revenue was up by 7% over 2018 and profits were up by 15% to $13.8 Billion.  Its hard to imagine a company that is that profitable actually doing better due to this virus, but it could be true.  Don’t take my word for it, a report from an industry analyst suggests; evidence points to drops in elective surgeries, doctor office visits and outpatient rehab visits.”


So, we find ourselves trying to come to grips with the new reality.  We are now familiar with terms like “social distancing” and “community spread”.  Many of us now have a newfound respect and admiration for the teachers that work with our children every day.  I know I do.  We try to come to grips with what is easily going to be the worst economic crisis since the great depression.  As we come to terms with all of this and express our appreciation for everyone on the front lines of this fight, we now face the very real possibility that large numbers of medical groups may not survive this event.  How sad will it be if the very people we are counting on the care for us during these difficult times become business casualties of this virus while the insurance companies’ profit.


These are difficult times.  Most of us are going to be impacted in some way or another before all of this is over.  I just hope that we don’t end up sacrificing the independent practice of medicine while adding to the coffers of insurance companies.


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