1/ This thread will be alarming, I'm sorry.

The American Academy of Family Practice CEO is crying out about the financial crisis threatening frontline primary care practices, but no one seems to be listening

I'll give you some news from those frontlines (and ask for your help) https://twitter.com/rshawnm/status/1241825785197060096
2/ We are hearing first hand the front end of a massive wave about to swamp PCPs

A family practice in Arkansas that's been in business for 50 years just laid off 12 staff member.

A practice in NC says they have 2 weeks until they go broke

This is one practice's cancellations
3/ Those are practices in areas that are NOT yet heavily impacted by the outbreak.

Here is what it looks like at a practice where the virus is spreading
4/ Our practices are TELLING their patients to stay home and stay safe, but that means that they don't get paid

If in return for being on the frontline of the healthcare system they're quarantines for exposure to a #COVID19 patient, they don't get paid https://twitter.com/Farzad_MD/status/1239378017157251072?s=20
5/ Many practices are trying to figure out televisits.

We @AledadeACO have done tech diligence, created an implementation toolkit, taken over implementation from swamped vendor, subsidized costs for 550 practices.

What about non-Aledade practices? https://twitter.com/Farzad_MD/status/1241536335233650688?s=20
6/ @CMSGov actions to make switch to televists feasible are excellent, and there is a big increase in televisits to be sure, but

a) it's still a small portion of total
b) many payers still don't pay for it
c) no one is paying for implementation costs
d) IT DOESN"T PAY AS MUCH
7/ As usual, follow @Travis_Broome for detailed policy understanding of the issue, but as he says:

"If a practice switches all their visits to telehealth 1:1 they will see a 30% decrease in revenue"

https://twitter.com/Travis_Broome/status/1240358387126341638?s=20

https://twitter.com/Travis_Broome/status/1240031226179846146?s=20 https://twitter.com/theacoshow/status/1240988682624159745?s=20
8/ So what is the US doing RIGHT NOW for practices with low financial reserves that are struggling with lack of personal protective equipment, risking exposure and infection, dealing with new technology costs, dwindling billable visits?

SBA loans https://twitter.com/rshawnm/status/1241712016210964481?s=20
9/ You are going to be hearing A LOT about the urgent need for a $240 BILLION bailout for hospitals in yet another stimulus bill to be passed imminently

There is nothing (yet) in the bill for primary care practices that are meant to be the first line of defense against #COVID19
10/ If primary care practices close because of this-especially in rural communities-there will be no capacity for either outbreak detection, or for primary care for patients struggling every day with chronic diseases

The unanticipated death toll could be much higher than #COVID
11/ I don't usually do this, but I'm asking for your help.

if you have followers, tell them about this.
If you're a journalist, look into this
If you care about primary care, tag your senator or member of congress

There are simple things we can do to avert this disaster:
12/ In a "Stimulus Bill" we MUST include support for frontline practices. It's moving quickly, and I don't know when there will be another chance, if ever

This string has details on what physician orgs are asking for.

simple/fast: primary care fee bump https://twitter.com/BobDohertyACP/status/1241448679749402626?s=20
13/ There are also more that @CMSGov @SeemaCMS @CMSinnovates could bring to bear on this even without congressional action.

*Increasing facility portion of televists
*Paying portion of anticipated shared savings checks now
*fixing "rural glitch"
*enabling "tele-AWV" (home BP)
14/ For primary care practices even as you try to salvage your fee-for-service business this should be another reason to consider value-based pay

You can think of it as hedging your bets or diversifying your revenue, but being paid only for visits billed is bad business for PCPs
15/ Getting recurring revenue (per member per month) for quality outcomes is great, managing to switch to capitated primary care payments provides more security, but the real game-changer is getting paid for better outcomes/ fewer hospitalizations, no matter how they're achieved
You can follow @Farzad_MD.
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