Will your doctor have to close up shop because of economic effects of the coronavirus?
Twenty-one years ago, Dr. Mythili Ramachandran moved to Bonney Lake as one of the few health care professionals in East Pierce County.
Ramachandran has seen generations of families over the years and enjoyed the freedom of owning her business, Bonney Lake Medical Center and Integrative Medicine. As a one-doctor practice, patients know who will see them, that she knows them and their medical history and that she can take as long as needed with them.
Like almost all businesses during the coronavirus pandemic, her practice and other small doctor’s offices have struggled. Ramachandran has seen her weekly patient load cut in half in recent months. She worries that she will have to shut down the office and take a job at a hospital or heath care chain.
“I haven’t given in because for me, it’s the connection with my patients,” she said. “I know I have seen three or four generations of patients. I know my patients, and I can advocate on their behalf, and I can send them to any referral.”
The pandemic is taking a toll on small medical practices across the state.
The Washington State Medical Association, which represents more than 11,000 health care professionals, conducted a survey in late April to gauge the financial loss to doctors from COVID-19.
Ramachandran was one of about 135 doctors who participated in the survey. About 55 percent of those who responded have laid off or furloughed staff, and more than 40 percent said they have stopped taking a paycheck, the survey found.
WSMA’s best practices standards suggest medical offices should have 18 weeks’ worth of cash on hand. The survey reported 73 percent of practices have one to six weeks of cash on hand.
Association president William Hirota said the pandemic has been devastating to everyone, but there are dire consequences when medical practices close. People suffer and can die from lack of access to medical care, he said.
Nearly 40 percent of survey respondents were solo practitioners, a business model that is slowly disappearing in Washington. Hirota said small, single-doctor, practices once made up the majority of health care providers in the state, but now less than half of all doctors work on their own in private practice.
Pandemic effects
Many of Ramachandran’s 3,000 patients now are seen using telehealth portals or apps. While she finds it very useful, she is concerned for her older patients with chronic conditions. Her senior citizen patients have had a hard time connecting or using the needed technology, and she worries that their health will deteriorate without regular check-ins.
“Telehealth requires video competency, but some of the most economically-challenged older patients don’t have this,” she said.
Ramachandran isn’t sure how she will be reimbursed for online services, or if it will cover the cost of malpractice insurance, the cost of a record-system and her three employees.
She and Hirota said smaller practices were already disappearing as large hospital chains and health care companies began growing. The Bonney Lake physician once was the only doctor in town. Now, MultiCare, a health care company, opened a hospital in 2019, and subsidiary clinics have since sprouted.
Larger health care companies can offer employers better insurance coverage by bundling, Ramachandran said. Many of her long-time patients transfer to the hospital because of insurance compatibility.
If small private practices are forced to close, Ramachandran said more of a monopoly on health care will lead to higher costs.
But even large companies aren’t immune to the economic stress of the coronavirus pandemic.
Hospitals are struggling to stay open as well. MultiCare announced last week that more than 6,000 employees were furloughed. Without elective surgeries and referrals, hospital revenue has plummeted.
President Donald Trump has signed coronavirus relief funds that included $75 billion for emergency hospital response. Congress has slated more hospital funding in ongoing Health Care Enhancement Acts.
Ramachandran said smaller practices have not been as fortunate in financial assistance from state and federal governments as hospitals. She applied for the Payroll Protection Program that provides low-interest loans for up to two months’ payroll, but her application was not approved.
The doctor said her office will stay open as long as she can afford to.
“COVID came at a time when small practices were strapped, and we were being edged out a bit,” she said. “Then this could be the final blow.”
