Primary Care on the Mend
April 28, 2020
Photo via Canva
The coronavirus has put intense stress on our primary care system. But, for some, the situation has begun to improve.
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Dan Gorenstein: Hey, Chuck how’s it going?
Chuck Jones: Good. A lot has changed since the last time we talked.
DG: One month ago, the situation looked grim for Harbor Health in Boston.
CJ: There’s not a light right now at the end of this tunnel that I can see.
DG: Like many federally qualified health centers, most of Harbor Health’s patients had stopped coming in and their monthly revenue had fallen off a cliff.
CEO Chuck Jones laid off about 200 employees and had to close one of their clinics.
Over the last few weeks, though, it looks like Harbor Health has started to turn a corner.
Today, from the Annenberg Studio at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.
DG: If Harbor Health’s situation has begun to stabilize, Chuck says there’s one reason.
CJ: So last time we talked, we were just at the start of this crisis and we’ve been able to replace most of the visits that were happening face-to-face.
DG: Harbor Health has leaned into telehealth so much, they have managed to convert almost all of their in-person visits to appointments over the phone.
They’ve all but shut down their dental practice.
Overall, Chuck estimates patient visit revenue is about two-thirds of what it had been.
CJ: The net of all this is that we’re still losing money, but it is not at nearly the rate that if you had drawn a straight line from the week or two after this crisis really hit us, we were looking at a month or two. Now we’re looking at four to six months of relative stability, give or take.
DG: Harbor Health is in better shape than many federally qualified health centers.
According to federal data, about one in six sites around the country have closed their doors temporarily.
One problem: some state Medicaid programs have decided to reimburse telehealth visits at much lower rates than in-person visits.
Massachusetts’ program — which covers most of Harbor’s patients — now reimburses telehealth at the same rate as an in-person visit.
Chuck says patients — many of whom are medically fragile or poor — are really taking to these new appointments.
CJ: They really appreciate the fact that they don’t have to leave their homes, which for many people is very anxiety-producing experience.
DG: But there are still some kinks to work out. Chuck says Harbor Health is learning sometimes phone calls don’t cut it, which is why they are ramping up video.
CJ: Another physician I was talking to was on the phone with a mom who spoke Portuguese with a three year old boy who had an itchy eye. The mom was focused on the eye and the boy, and the doc was concerned about asthma and allergies. It’s challenging to fully rectify that over the phone. So that’s a case where the video is really going to help.
DG: Even with all the advancements Harbor has undergone, for some — Chuck says — there’s no replacement for in-person visits.
He estimates about 140 patients still need to come in each week for things like diabetes testing, blood pressure readings or breast exams.
Chuck, now that you’re feeling more stable financially, what’s the biggest challenge you’re facing?
CJ: It’s funny that the agenda for our daily 4 PM COVID crisis meeting at Harbor really reflects the sort of priority of what’s going on. Three weeks ago, it was telehealth, telehealth. It was PPE. Now it is testing and contact tracing.
DG: I want to understand this testing plan. Who are you going to offer tests to? And what’s the setup going to look like? What do you guys imagine?
CJ: Each facility may be a little bit different. But the common theme is for patients who are coming in who are likely COVID-positive to have a testing process. If we can do it without them getting out of their car, great. Otherwise, we’ll have a tent outside each facility that they can walk into and get the tests there without sort of entering the facility and then having us to have to worry about decontamination and exposure to other patients and staff inside the facility. The process doesn’t end there. At that point, we then need to track the follow-ups and make sure that we’re contacting that patient and then reaching out to anyone that that patient had contact with to make sure they’re getting the health care that they may need and the screening that they may need.
DG: So that sounds like a really nice game plan, Chuck. But what challenges, if any, are you guys facing in sort of making this vision a reality?
CJ: I mean, two weeks ago, the challenges to this plan were insurmountable. We can’t get test supplies. So we don’t have the swabs, we don’t have sufficient PPE, and without those two things we really can’t start up testing. We could run for one day before we ran out of supplies.
DG: But in just the past week, he’s started to see supplies trickle in.
CJ: We’ve gotten incredible support from all areas, even construction companies, Feeney Brothers here, they dropped off hundreds of N-95 masks. The mayor of Boston has been very supportive in directing the Boston Resiliency Fund. The governor in support of health centers in general in making sure that Quest Diagnostics is connecting with community health centers and providing all the tests that we need in the state to move forward with a more robust testing program.
DG: Harbor Health still needs more PPE.
One patient is so appreciative that the clinics have kept the doors open, he’s doing everything he personally can to pitch in.
CJ: We had one of our patients who was actually hospitalized earlier in the year. His house burned down while he was in a coma. He got out and is now committed to sewing masks for the Harbor staff and our patients
DG: Are you kidding me? This guy who had his house burned down, this guy come out of the hospital, he’s sewing you and your staff masks?
CJ: Yeah, he found a sewing machine. I have a picture. He’s literally sewing masks for harbor and our patients. That’s how much these services mean to people in our communities.
DG: Now you’ve been through this first wave, Chuck. How are you thinking about being ready for a second wave experts are predicting?
CJ: Well, it doesn’t feel like we’re necessarily coming off of the first wave just yet. It’s not like we’ve seen a huge decrease. I think preventing that second wave is really what we’re focused on right now in terms of testing and screening. I think we see that as the number one and two priority for us to be able to prevent that second wave from coming in.
DG: Harbor Health is certainly better off than it was a month ago thanks to the explosion in telehealth and additional support from Massachusetts and the federal government.
Other health centers around the country are less fortunate and continue struggling to keep the lights on.
But, even for Harbor, the best thing Chuck can say about their financial situation right now is that they’re temporarily stable.
I’m Dan Gorenstein, this is Tradeoffs.
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Select Research and Reports on Primary Care:
What Impact Has COVID-19 Had on Outpatient Visits? (Ateev Mehrotra, Michael Chernew, David Linetsky, et al; The Commonwealth Fund)
Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015 (Sanjay Basu, Seth Berkowitz, Robert Phillips, et al; JAMA Internal Medicine; 2019)
The State of Primary Care in the United States (Robert Graham Center, 2018)
Federally Qualified Health Centers:
Under Financial Strain, Community Health Centers Ramp Up For Coronavirus Response (Will Stone, NPR, 2020)
Chuck Jones, President and CEO, Harbor Health Services
The Tradeoffs theme song was composed by Ty Citerman, with additional music from Checkie Brown.
This episode was produced by Victoria Stern and mixed by Andrew Parrella.
Additional thanks to:
Michaela Keller, Susan Sumrell, and the Tradeoffs Advisory Board…
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