Finally getting around to that annual physical? Here's what you might find

Some patients looking to reschedule annual physicals, wellness visits or other routine medical appointments long delayed by COVID-19 first may need to make time to find a new doctor.

Thousands of practices have closed because of the pandemic, a recent survey shows, with thousands more planning to close in 2021. Finding a new doctor means more than just making sure the provider is covered by your insurance, said Dr. Jennifer Bacani-McKenney, a family physician in Fredonia, Kansas.

"Safety protocols are important. Do they require a mask for patients and staff?" she said. "Do they have hand sanitizer available at the front door?"

President-elect of the Kansas Academy of Family Physicians, Bacani-McKenney has owned and managed her own practice for more than a decade. She recommends looking for a physician who offers flexible options for patients, a sign of a commitment to quality care that will last beyond COVID-19.

For instance, most doctors now offer telehealth services. Bacani-McKenney's practice started offering curbside visits during the pandemic.

"How willing is your doctor to meet you where you feel most comfortable?" Bacani-McKenney asked.

Practices have adapted amid their own challenges.

Dr. Wayne Altman, co-owner and president of the Family Practice Group in Arlington, Massachusetts, is a professor and chair of family medicine at Tufts University School of Medicine. He said most practices have adjusted as best they can to the "new normal." For instance, Altman said, the pandemic forced many employees with children to juggle work schedules with priorities at home as schools transitioned to online learning.

COVID-19 struck at a time when primary care already was facing a looming crisis.

A July 2020 report by the American Association of Medical Colleges estimated a primary care physician shortage of between 21,400 and 55,200 by 2033. A large portion of the physician workforce is nearing retirement age, and there are growing concerns about physician burnout, the report said.

The financial fallout from the pandemic led to more worries.

In another July 2020 survey, the Physicians Foundation found that 8% of doctors have closed their practices in 2020, which amounts to roughly 16,000 practices. The survey found that another 4% expected to close their practice within 12 months.

The same survey found that 72% of doctors had a reduction in income due to COVID-19. By December, a different report from the Larry Green Center and Primary Care Collaborative found that 52% of practices said payments were "worse" than in spring 2020.

"Primary care, the foundation of our fragile health system, is on the verge of collapse," the authors of that report wrote.

Altman said the health care system's fee-for-service payment model "aligns incentives in the wrong way." Doctors are paid by insurance companies based on productivity, such as the number of patients seen in the office or procedures performed. He instead supports a model providing monthly payments for doctors per patient. This would help primary care offices invest in services that have not traditionally been paid for by health insurance such as telehealth, counseling, health coaching, home visits and other important components of care.

Telehealth options that became more popular during the pandemic are here to stay, Altman said. "If you're looking for a new doctor, you should really make sure that they're offering telehealth, and most are."

However, different insurance carriers have different sets of payment rules for visits that are telehealth versus in-person, Altman said. Massachusetts has a state law that keeps them the same for two more years, though Altman added that does not apply for patients with national health insurance carriers.

The health insurance payment maze makes it challenging to figure out the right way to run a business, he said. "But what most doctors have done is focus on taking care of their patients as best as they can."

Bacani-McKenney said she didn't take a salary for about the first month of the pandemic as her practice figured out how they were going to safely operate. A Payment Protection Program loan helped the business with 14 employees stay afloat until they were able to start seeing patients again.

She encouraged people who have lost their primary care doctor to begin looking for a new one as soon as possible, even if just to begin with a telehealth visit. A good doctor will want to know about a patient's medical and personal history, Bacani-McKenney said.

"We really need doctors to focus on the social determinants of health, someone who is aware that health is more than just medications and a diagnosis," she said.

"Your doctor should take time to know you well from the very beginning so they can care for you as best as they can."

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