Modesto-area medical practices in survival mode after loss of patients, lack of aid
The economic grip of the coronavirus pandemic is forcing some California primary care doctors out of their practices.
More than one-third of Californians, about 13 million people, could lose access to a primary care provider unless state and federal governments take actions to mitigate COVID’s financial hit, according to the California Medical Association.
People aren’t going to their doctors’ appointments out of fear of exposure to COVID-19, jeopardizing their health as well as the financial sustainability of medical practices, including those in Stanislaus County.
“We have absolutely had a decrease,” said Dr. Silvia Diego. “There are a lot of patients afraid to come because of COVID.”
Diego and Lisa Gil are family medicine physicians and business partners in their practice, Family First Medical Care on Oakdale Road in Modesto. They employ an additional five part-time medical providers and 40 support staff and have a roster of 10,000 to 12,000 patients. They take care of all age groups, but have an emphasis on women and children.
At the outset of the pandemic, Diego said their group promptly started telehealth visits and made arrangements for in-person visits for priority patients, such as prenatal visits for pregnant women and checkups and vaccinations for young infants.
Even with those adjustments, she estimated their practice has had about a 40% loss in income since the start of the pandemic.
They are not alone.
Virtually all (98%) of the 3, 246 practices reported seeing a drop in patient visits and a greater than two-thirds loss in revenue from March 1 to mid-April in the Physician Financial Health Survey conducted by the CMA.
In addition, 67% of the medical groups reported reduced hours for physicians and staff, and 11% temporarily closed. Nearly 95% were somewhat to very worried about their practice’s financial stability.
More than half of small practices (those with fewer than five physicians), compared to 22% of large practices (with 51 or more providers) were worried their practice would close permanently, according to a survey from the California Health Care Foundation.
“In a small private practice, we can adapt to changes more quickly, but we don’t have the cushion that large groups have,” said Diego.
When government funding programs for small businesses were announced, Diego said, “We applied for everything, because we don’t have a cushion.”
Applying for aid through Stanislaus County
Her medical group was one of seven physician offices that applied for and received a grant with a maximum of $10,000 from Stanislaus County to support small businesses during COVID-19.
Diego’s practice also received funding from the federal government Payroll Protection Plan under the Coronavirus Aid, Relief and Economic Security Act (CARES).
The $2 trillion CARES Act, which began dispersion in April, allocated $100 billion for hospitals, physicians, and other health care providers.
The initial $30 billion was provided as grants to hospitals and physician practices in proportion to their share of Medicare fee-for-service spending in 2019. A second round of funding was dispersed based upon 2018 billing from all payers, not only Medicare.
The formula used for distribution of federal funds focused more on large hospitals, with higher revenues because they have more Medicare and privately insured patients, than supporting small and community-based practices.
In addition, Medicare fee-for-service primarily covers people 65 and older, so some practitioners, such as pediatricians and obstetricians, were excluded from the early assistance.
Modesto area already limited by access
Loss of primary care providers in Stanislaus County, and all of the Central Valley, can be described as an insult to the already existing injury of an inadequate health care workforce.
In 2017, the most recent data available, Stanislaus County had 282 primary care doctors for nearly 539,000 residents, which is about 52 doctors per 100,000 people, according to the California Health Care Foundation. Nearby San Joaquin County has the same number of doctors to serve a population of more than 720,000, equaling about 32 doctors per 100,000 people.
This is far short of the 80 to 100 doctors per 100,000 people recommended by the World Health Organization, and pales in comparison to the 114 primary care doctors per 100,000 in affluent Napa County.
Multiple research studies have shown that having a primary care provider matters. People who have a regular source of medical care are more likely to get recommended preventive services, such as immunizations, blood pressure monitoring and cancer screenings. They’re healthier.
Maintaining routine health checks with a primary doctor is associated with lower medical costs for the individual, as well as society.
In addition to private offices, Stanislaus County and neighboring counties rely heavily upon Federally Qualified Health Centers. FQHCs primarily serve low-income individuals and have more ethnically/racially diverse populations. The county has at least three health organizations that are FQHCs or look-alikes, which operate similarly but have different funding mechanisms.
FQHC revenue is dependent upon the number of visits. Without patient visits, reimbursement from Medicare and MediCal (California’s version of Medicaid) quickly plummets, threatening sustainability.
Golden Valley Health Centers impacted
California has 178 active FQHC and accounts for seven of the top 10 total visits in the U.S. Golden Valley Health Centers has the 3rd highest of all FQHC visits in the U.S., with more than 77.6 million total client visits (about 150,000 per year).
GVHC, one of the largest FQHC and MediCal providers in the Central Valley with about 40 clinics in Stanislaus, San Joaquin and Merced counties, furloughed or laid off 25% of its staff in early April in an attempt to head off financial demise.
None of Golden Valley’s primary care providers were furloughed but GVHC did temporarily close four clinics, including locations in O’Banion in Merced, Dos Palos, Westley, and a small site in Modesto. They plan to re-open these sites as needed to meet demand.
In an email to The Bee, GVHC reported about a 30% decline in visits since the start of the pandemic. They also received some funding through the CARES Act.
Dr. Diego said she’s not aware of any of her physician colleagues who have closed their offices permanently, but a few had to close temporarily due to the decline in visits.
She said her practice is financially secure through June because of the government assistance programs. Starting next week, they are increasing the number of patient appointments, especially for immunization visits to catch-up infants who with delayed vaccines and for children and teens preparing to go back to school.
“We are committed to our patients and our staff,” said Diego. “We want to be here for them.”
This story was produced with financial support from The Stanislaus County Office of Education and the Stanislaus Community Foundation, along with the GroundTruth Project’s Report for America initiative. The Modesto Bee maintains full editorial control of this work.
To help fund The Bee’s children’s health and economic development reporters with Report for America, go to bitly.com/ModbeeRFA
This story was originally published May 29, 2020 at 5:00 AM.
