Delaware County dermatologist Joseph Laskas normally sees 130 patients a week.
Now he’s down to five or six patients a week since commerce — including wide swaths of the health-care industry — screeched to a halt last month amid measures to slow the spread of the coronavirus.
“It’s a huge decrease," said Laskas, who is one of 10 doctors at Dermatology Ltd., which employs 53 in offices in Media and Glen Mills. "For all intents and purposes, the business is closed, except for everybody’s still on payroll.”
The practice is looking at every angle for financial relief and wants to keep paying employees. “So far we’ve been doing that, but it can’t go on forever,” Laskas said.
Physician practices like the one where Laskas works employ 55,000 people in the Philadelphia region, and the coronavirus pandemic is hammering them financially, because all non-urgent medical care is being postponed indefinitely to prevent the spread of the virus.
Hospitals are facing a similar squeeze, with revenues and volumes down in the 40% range, according to sources. But most of those institutions are better equipped financially to handle the slowdown than physician practices, typically small businesses that lack the reserves to pay bills for long without money coming in.
The pandemic is going to lay bare “the chasm of haves and have-nots in our health system,” said Lynda Mischel, a principal at Veralon, a Philadelphia-based health-care consulting firm.
Large practices have the advantage of huge pools of patients that will help them come back when the crisis passes. Smaller practices will have a harder time recovering, Mischel said. “They have probably by and large laid off their staffs or furloughed their staffs, and financially are in a lot of trouble," she said. "They have rent to pay.”
For all talk of how telemedicine has come into its own, the method looks much different to a specialist in a small practice than it does to a doctor employed by a large system.
University health systems such as Jefferson and the University of Pennsylvania are still able to pay doctors’ salaries because they have a lot of reserves and endowments, said Brian Broker, one of six physicians at ENT & Allergy Specialists, which has four offices in Philadelphia’s western suburbs.
“We have none of those things," Broker said. “We’re private groups. The doctors are all living on their savings because we’re not going to do enough televisits to take a salary.”
Revenue is down more than 90% at ENT & Allergy Specialists, Broker said, because most of it comes from procedures and tests for hearing, allergies and breathing, along with infusions, injections, and endoscopies.
“An office visit is a teeny piece of it," Broker said. “Now, you’ve taken all those procedures away. Plus, you’ve taken at least three-quarters of the volume away. Now we’re down to just one quarter of the least revenue-generating portion of what we do.”
ENT & Allergy Specialists had 40 employees. Now it’s down to 10, Broker said.
The practice is looking at loan programs it might be eligible for, such as the Paycheck Protection Program created by the $2 trillion Coronavirus Aid, Relief, and Economic Security (CARES) Act . The loans are limited to companies with fewer than 500 employees, and the loans will be forgiven if certain requirements are met, such as continuing to pay employees.
For ENT & Allergy Specialists, “the question is, can we bring them back?" Broker said. "It’s one thing if we had the payroll support, but we still can’t bring them back if we don’t have any volume.”
Cardiology Consultants of Philadelphia and other large groups were left out of the massive CARES stimulus package, said Mark Victor, CCP’s chief executive. CCP has 570 employees spread across 36 offices, which means it’s a little too large to be eligible for the Payroll Protection Program.
So far, CCP has kept paying staff. To do so, physicians gave up their paychecks, Victor said. “That’s going to be hard to maintain for any long period of time.”
Like most specialty practices, CCP is bringing in just a fraction of its normal revenue because virtually all testing is being postponed, including ultrasounds to see how well a patient’s heart is working and cardiac catheterizations to diagnose and treat heart disease, Victor said.
Despite the disruption, Victor said he is enthusiastic about how telephone visits with patients have gone over the last three weeks. “I firmly believe that this will persist long after this crisis goes away,” he said.
If a telephone visit reveals that a patient needs to see a doctor, the patient goes to one of CCP’s six triage centers. “We’re having people literally wait in their car” to make sure only one person at a time is in the office, Victor said.
Similarly, at Meetinghouse Family Physicians, a three-doctor primary-care practice in Marlton, only one patient at a time is allowed in the waiting room, said Sloan Robinson, a doctor there. Patient volume is down significantly since Meetinghouse postponed all routine visits, but patients still need a place to go sometimes, Robinson said.
On Thursday, he saw an older woman with blood in her urine. “She’s got to be seen," Robinson said. "You can’t pat her on the back, and you don’t want to send her to the emergency room.”