Tuesday Apr 28, 2020
COVID-19: Lessons Learned So Far
"I'm gonna soak up the sun"
-- Sheryl Crow
We are now in the eighth week since the World Health Organization declared the disease outbreak caused by the SARS-CoV-2 virus a pandemic. In the past six months, the virus has wreaked havoc on health care systems around the globe. Irrespective of the perceived capabilities and state of readiness of any system, COVID-19 has tested and strained the physician workforce, hospitals and health care systems in numerous countries.(www.cdc.gov) It also has brought to light the limitations and shortcomings of domestic and global medical supply production and distribution systems.
Here in the United States, more than 950,000 people(www.cdc.gov) have been confirmed to currently be, or previously have been, infected with the virus, and our total number of deaths exceeds 53,000. Worldwide, more than 2.9 million people(covid19.who.int) have been confirmed to currently be, or previously have been, infected with the virus, and the total number of deaths worldwide is more than 202,000.
Each day, I receive emails and phone calls drawing my attention to the heroic leadership and contributions of family physicians on the front lines of this crisis in hundreds of communities across the United States. Each of these stories demonstrates something different about family medicine and family physicians, but not surprisingly, each has something in common: In times of crisis and times of human need, family physicians step forward to provide care to their communities, regardless of the circumstances. I am inspired by the individual stories, but more importantly, I admire each of you for who you are, at your core.
There are numerous lessons that we will learn, or should learn, from this pandemic. As I have noted in previous posts, there will be a desire to move quickly to identify "solutions" to the challenges identified by the COVID-19 crisis. It also is highly likely that many of these so-called solutions will be promoted by individuals and companies that have a financial interest in what they are proposing.
For family medicine, and primary care more generally, there is one lesson that rises above all others. That is the need to quickly implement payment models that are aligned with first-contact, comprehensive, continuous and coordinated primary care delivery.
Spoiler alert: Fee-for-service doesn't fit the bill.
I recently wrote about the need to transition primary care away from the legacy fee-for-service system toward a longitudinal delivery system supported by prospective payments. This call to action is being harnessed through an idea called the Primary Care Marshall Plan, but the major components already exist in the Primary Care First model that CMS is poised to implement in 2021.
Although the need to reform primary care payment is the most obvious and pressing policy issue, there are other lessons that we should take away from this crisis. Here are a few of my top observations:
Observation No. 1: Family physicians, through their full-scope training, are uniquely positioned to deliver comprehensive care to patients and communities. Without question, the ability of family physicians to transition between age groups, health conditions and care settings is unmatched in the physician workforce.
As AAFP Board member Margot Savoy, M.D., M.P.H., said in a recent meeting, "We (family physicians) are asked to cover for everyone else in the clinic and hospital, but no one seems capable of covering for us. Maybe that tells us something."
This is a keen insight, based in actual experience. We have witnessed the value of full-scope family medicine for years, especially in rural communities, but as the COVID-19 crisis expanded, it was family physicians who took on new responsibilities during surge staffing. The expansive skill set of a family physician makes you the most versatile and valuable member of the physician workforce. I wrote about this versatility in skill and scope several months ago when I explored the concept of plasticity in family medicine. (The concept of plasticity in family medicine originated with Erin Fraher, Ph.D., M.P.P., a professor and researcher at the University of North Carolina at Chapel Hill School of Medicine.)
In that post I noted: "Family medicine is without peer when it comes to comprehensiveness. As a matter of workforce policy -- and this is important -- family physicians can provide a broader scope of services to each individual patient, thus reducing current levels of necessary workforce for some nonsurgical specialists."
My conclusion in that 2019 post was essentially the same as Dr. Savoy's: "The plasticity of family medicine allows the discipline to maximize its capabilities in response to the needs of the patient and/or community being served."
Observation No. 2: As we draft the blueprints for the future of family medicine, we must make certain that we are not constrained by 20th century constructs and, instead, embrace the opportunities of incorporating 21st century technologies into the practice of family medicine.
Case in point, Randa Perkins, M.D., a family physician from Florida, recently posed the following question on Twitter:(twitter.com) "Why has family medicine not rebranded telemedicine as modern house calls?"
This is a fair question and an excellent recommendation. In many ways, telemedicine is the 21st century house call, and family medicine should not only embrace the use of telehealth and virtual visits, but we should make certain that moving forward, these services are part of comprehensive family medicine practice and not a stand-alone, direct-to-consumer product. To date, we have largely viewed telemedicine as a tool (like an X-ray) versus a modality of care, which has resulted in draconian rules and regulations governing its use. As both family physicians and patients become more comfortable with virtual engagements, incorporation of this modality of care into family medicine practices will expand access and capacity and create a more patient-centric delivery model. I also hear through the grapevine that family physicians are growing quite comfortable using telehealth, which is a good thing!
Observation No. 3: The rural health care system would not exist without family physicians. I am not being flippant or disrespectful, but family physicians are the foundation of the rural health care system. You do not see many internists, pediatricians or obstetricians in these communities -- you see family physicians.
HealthLandscape(www.healthlandscape.org) conducted an analysis to determine the impact of family physician practice closures on access to care, jobs, and wages and salaries. The model(www.healthlandscape.org) shows the devastating impacts over a three-month period on access to care and the economic viability of communities, especially rural communities, should family physician practices close. The analysis was featured in an April 2 USA Today cover story.(www.usatoday.com)
The AAFP has a major rural health initiative underway called Rural Health Matters. The COVID-19 crisis has shown how important family physicians are to rural communities and how urgent our work to improve the rural health care system is for thousands of communities and millions of people.
The AAFP continues to produce content, tools and resources aimed at assisting you and your practice in these unpredictable and challenging times. I encourage you to frequently review our COVID-19 resources. This is where you will find the latest member communications from the AAFP and information on COVID-19-related CME, practice management, telehealth, clinical resources and patient education, and advocacy.
I also encourage you to join us each Wednesday at 7 p.m. CT for our AAFP Virtual Town Hall meetings.
In closing, thank you for all that you are doing for your patients, your communities and the country. Be safe. Take care of yourselves, your families and your communities.
Posted at 11:38AM Apr 28, 2020 by Shawn Martin