• In The Trenches

    How to Improve Pandemic Response? Fortify Family Medicine

    The nation's response to the global COVID-19 pandemic showed impressive adaptability. Bourbon distilleries started making hand sanitizer. Shoe companies shared mask-making templates with other manufacturers. Workers in every corner of the economy learned how productive they could be from their kitchen tables.

    Background sandbags of trenches world war one

    Family physicians adapted, too, turning a broad scope of training into a rare shining star. Many of you picked up long shifts in emergency rooms or other care settings rocked by staffing shortages. And, of course, you have swiftly embraced telehealth.

    But the system was not set up to support these important actions. State licensure or visa limitations prevented some physicians from volunteering in hot spots. Others were unable to fill gaps because their health insurance would not provide in-network coverage if they were to need care themselves where they wanted to serve. And much of the funding freed up by Congress bypassed the primary care practices that were in desperate need of support.

    Next time, we must be fully prepared rather than heroically adaptable.

    Going forward, the AAFP told the Senate Health, Education, Labor and Pensions Committee this month, we need a comprehensive strategy to facilitate family physicians' ability to provide care where it is needed most.

    The Academy wrote in response to the committee's June request for information on pandemic preparedness. Our letter laid out a plan for turning the hard lessons of the past few months into a strategy for greater effectiveness in the future -- one centered on well-fortified primary care.

    Among the crucial landmarks on any new map to preparedness: a reliable supply chain for personal protective equipment.

    One of the first ways in which the pandemic affected family physicians was the lack of access to PPE. Members purchased disposable raincoats when they ran out of gowns or enlisted help from local high schools to make face shields. Others had to close down their practices temporarily because they were not able to safely see patients without PPE. Those who found stockpiled PPE often ended up receiving rotted or otherwise unusable gear. And when supplies began coming back online, hospitals aligned with group-purchasing organizations often had first pick; in too many cases, PPE didn't make it to off-site practice locations.

    For now, the Academy has partnered with Amazon to whitelist small practices to ensure they have priority access to purchase necessary supplies. We also are working with Project N95 to help diagnose PPE shortages and gather information about reputable suppliers.

    Going forward, the Academy told the committee, a complete national strategy must be put in place to get supplies to community-based practices. The country must plan better to do better.

    Additionally, for many family physicians, point-of-care testing remained unavailable for several months. That inability to test patients created a delay in diagnosis, unnecessarily diverted patients to hospitals, potentially exposed patients to additional risks, and challenged capacity. Broader recognition of the important role that community-based primary care plays in pandemic response, the AAFP told lawmakers, is critical to more effective interventions.

    And then there's the money.

    The pandemic's cataclysmic impact on state budgets cannot be understated. The Center for Budget and Policy Priorities estimates a cumulative state budget shortfall of $555 billion over fiscal years 2020-22 -- setting the stage for budget surgery that makes deep cuts to health care. Sweeping job losses are creating a huge influx of Medicaid-eligible beneficiaries, adding pressure on states to reduce either benefits or payments to physicians.

    It's time to correct the countercyclical nature of the Medicaid program, which now increases program obligations and spending in times of economic stress. The Academy believes that the Medicaid federal medical assistance percentage must be altered so that it is tied to economic indicators, and has endorsed the Coronavirus Medicaid Response Act, which would connect the FMAP to state unemployment levels and bring federal aid increases into accordance with states' needs. For now, states must rely on Congress to obtain an FMAP increase; this legislation would remove that requirement and allow more appropriate decision-making.

    Likewise, the pandemic-driven surge of eligible Medicaid beneficiaries underscores the unsustainable discrepancy between Medicaid and Medicare rates. We have urged Congress to pass the Ensuring Access to Primary Care for Women and Children Act of 2020. This legislation would raise Medicaid rates for primary care services to Medicare levels for two years during and immediately following future public health emergencies to ensure that there are no disruptions to care.

    As Congress considers these steps and ponders how to ready the country for future health crises, we know that this one isn't over yet. Challenges to the supply chain still exist and likely warrant federal intervention. There are already concerns about a potential shortage of syringes in preparation for administering a COVID-19 vaccine, and Congress must be reminded of the consequences of not properly equipping medicine's front lines.

    What's clear is that family physicians continue to be critical in the fight against COVID-19. And you'll be no less needed during any future pandemic. So we will continue for advocate for every resource and consideration you need to meet that challenge.

    Stephanie Quinn is senior vice president of advocacy, practice advancement and policy.


    Stephanie Quinn, AAFP senior vice president of advocacy, practice advancement and policy.  Read author bio »


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    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.