The first step to repairing the U.S. healthcare system is focusing on primary healthcare workers and restoring their under-resourced ranks. Evidence shows that primary care teams are capable of remarkable health improvements when appropriately trained, paid, and given the capacity to reach out to every population they serve.

Primary health workers deliver nearly all the services responsible for longer lives, including those services for potentially stopping the next pandemic. They are the backbone of a functional and effective health system. They also play a vital role in closing gaps in access to other kinds of lifesaving care. And, for those segments of the population that remain underserved by the healthcare system, primary care often serves as the only provider to help diagnose, treat, manage, and prevent the chronic conditions that plague much of the country.

However, the primary care professionals who deliver the needed testing, vaccinations, and treatments to the community at large, and to underserved populations, are routinely among the most neglected and underfinanced part of the healthcare work force.

Independent primary care practices have faced enormous pressure for years, but now face a pending “perfect storm” of influences that further threaten their existence. Consider the confluence of the following events and their potential — and guaranteed — impacts on primary care in the U.S.

The end of the Covid-19 Public Health Emergency (PHE) will thrust more responsibility for public health onto already-stressed primary care practices. Telehealth reimbursement rates may revert to pre-pandemic levels, reducing the financial incentives for practices to offer these services. Millions may lose Medicaid/Children’s Health Insurance Program (CHIP) coverage because of the omnibus bill signed at the end of 2022.

The pandemic also led to the suspension of some quality reporting requirements, and practices should prepare for these requirements to resume. Plus, as the pandemic’s mental health impacts become more apparent, primary care physicians must be prepared to address the growing demand for mental health services and support.

Meanwhile, the well-publicized healthcare staffing woes that have decimated provider ranks across-the-board have pushed many independent practices to the brink. In addition, physicians and nurses, millions of medical assistants, home health aides, and nursing assistants will be needed within the next five years to meet demand, especially as 10,000+ baby boomers age into Medicare daily.

Clinician burnout rates continue to rise and contribute to attrition. Nursing burnout is particularly alarming, with many nurses retiring early and younger nurses leaving the profession—there are turnover rates between 30-60% among new graduates.

Administrative burdens are snowballing with new reporting and data-sharing requirements mandated by the Trusted Exchange Framework and Common Agreement (TEFCA) and the 21st Century Cures Act poised to place greater demands on practices.

According to CMS, all Medicare payments and most Medicaid payments will be governed by value-based contracts by 2030. The shift to value-based models is a daunting task, especially for those practices treating complex and underserved populations.

To help practices remain fiscally viable and independent, we must support them so they can focus on what matters most – practicing medicine. What’s interesting is that many primary care providers inherently deliver value-based care already. They need support delivering frontline care in the often-underserved communities where they operate. They need access to technologies that help automate labor-intensive back-office functions, identify and close care gaps in their patient panels, conduct telehealth, and flag high-risk patients or patients who may struggle with Social Determinants of Health (SDoH).

We must provide independent practices with the support to facilitate the transition to value-based care, empowering them to keep their doors open while making the move to alternative payment models. They need resources to help them get paid for the quality care they provide.

Independent primary care practices are at risk of extinction. The U.S. must re-dedicate itself to the preservation of independent primary care over the long run and must undergo a radical reorientation of the health system toward primary care.

Photo: aldomurillo, Getty Images