Tampa Bay Pediatricians Struggling During Pandemic
As parents, how comforting is it to have a pediatrician you trust to take care of your child? Helps you sleep at night, right?
What if we see a trend after this pandemic where pediatricians have to close their doors? That could happen. This is a very real and overlooked problem for pediatricians. Most primary care clinics, including pediatric offices, are small businesses. However, pediatricians receive the lowest reimbursement of any specialty of physicians and as a result of that, pediatric offices run on thin margins. This means that many of these practices across the country face the possibility of having to close their doors for good because of the significant drop in patient volume as a result of the COVID-19 crisis.
Across the country physicians are seeing a 60% reduction in visits. The Department of HHS has earmarked $100 billion dollars to support frontline health workers and hospitals. As part of that funding, the Trump administration announced that Medicare providers could apply for upfront or accelerated payments for anticipated claims volume. In other words, to offset the decrease in patient visits, physicians could apply for funds to be paid now for patients they will see in the future. In announcing this plan, Seema Verma stated that, “The major disruptions to the healthcare system caused by COVID-19 are a significant financial burden on providers. Today’s action will ensure they have the resources they need to maintain their all-important focus on patient care during the pandemic.”
However, these funds are tied directly to Medicare reimbursement, but pediatricians do not participate with Medicare because they do not care for adults. The only government program available to pediatricians is Medicaid, which is run by each individual state and only partially funded by the Federal Government. In Florida, Medicaid reimbursement typically pays 50% of Medicare rates for the same services provided to adults. This is despite the fact that most of pediatricians’ patients cannot communicate with them directly or are frequently so scared during their visit that it makes it very challenging to perform a physical exam. In addition, Florida Medicaid is not offering any similar funding programs.
This reduction in patient volume is great news, as it indicates that social distancing is working to not only prevent the spread of coronavirus, but it is also preventing the spread of all other common illnesses, as well. The bad news is that the fear of COVID-19 has many families avoiding taking their children in for well visits and vaccinations. This lead to the CDC to issue a warning on May 8, 2020 stating that we will start seeing outbreaks of vaccine preventable illnesses, such as the measles, if the current drop in vaccine administration is not get corrected. In the 5 weeks following the declaration of the National Emergency, the CDC noted that the Vaccines for Children’s program, which is responsible for vaccinating about 50% of the children in the US, saw a decrease of vaccine administration by as much as 70% in children under 2 and as much as 90% in children over the age of 2. If those rates continue, the implications will be devastating for the health care of our children…the most vulnerable in our population.
With the skyrocketing unemployment numbers, many children are also going to be shifted from private health insurance to Medicaid. Because of the disparity in reimbursement, many providers choose not to accept this insurance. Those pediatricians who do care for these children are put in an exceedingly difficult situation. Like many small businesses throughout the world, they are faced with decreased revenue due to lack of visits. However, this is compounded by the fact that many of their patients will now be insured by Medicaid thus deepening the financial burden. Adding that to the pediatricians being overlooked by the Department of Health and Human Services could lead to a severe shortage of pediatricians to care for our children.
If these practices close, where are our children going to go to get the preventative our kids care need to grow to be productive adults? Who are the parents going to call in the middle of the night when their child has a 104 degree fever or can’t keep fluids down because they are vomiting? Where are they going to take them when the system is overwhelmed once the pandemic is over and offices have closed? Who is going to be there to vaccinate our children to prevent them from getting preventable illnesses? Even worse, who is going to care for the children who get measles or pertussis – both of which have been responsible for outbreaks in the Tampa Bay area over the past several years.
The American Academy of Pediatrics has been working hard advocating for the Federal Government to consider this when allocating funds. Unfortunately, despite Seema Verma stating that pediatricians would be part of the 2nd round of funding, pediatricians were left in the dust again. Perhaps help is on the way but for some offices that may be too late.
