The 'PIR' Study
WELCOME TO THE Provider Insurance Revenue STUDY
Since the beginning of the COVID-19 pandemic in March, 2020, Physicians and other medical Providers have taken devastating hits to their practice revenues. Most of the losses are due to doctors being forced to curtail elective procedures and office visits as Americans were ordered to stay home during the height of the national health emergency.
As Physicians were able to return to work in the early Summer, even if only partially, many had to adjust to the newer medical practice of telehealth, and the lower revenues that came with it. The Centers for Medicare & Medicaid Services (CMS) gave assurances to Physicians that Medicare would reimburse telehealth encounters at 100% of the office visit rate. But private Payers were under no such obligation. Across the country, Physicians are reporting that they’re being reimbursed at about 70% of an office visit rate despite the fact that telehealth requires both resources and expertise to implement effectively, and each encounter takes up to twice as long as an office visit.
Adding to financial hardships, Physicians across the nation are reporting that legitimate insurance claims are being held up and denied by the insurance companies at a higher rate than ever, cutting off the cash that they need so desperately. As of June 1, only half of Physician practices say they have enough cash to stay open for another month.
In just 2 months in the spring of 2020, over 45 million Americans lost their jobs and for many, that also meant the loss of their employment-related health insurance. Despite shedding a massive number of members from their rolls, health insurance companies are actually predicting record profits for 2020. The pandemic it seems, is very good indeed for the health insurance business. Private investors and executives are taking huge dividends and bonuses out of the system just at a time when US healthcare needs a vast new investment of healthcare resources into the system. The good fortune of a few individuals and corporations comes at an as yet untold expense to American society.
The formula for insurance company success in a pandemic only happens one way. By keeping member premiums, delaying payments, and denying treatment authorizations, the large health insurance companies are taking advantage of the profound misfortunes of both doctors and patients during a national health emergency.
The COVID-19 pandemic will have adverse effects on the health of Americans that will be sprawling and long-felt. However, it is not for this study to decide whether private interests will always be antithetical to public interests when it comes to healthcare. That is a public debate that will continue to evolve as the profound weaknesses of the American way of distributing healthcare are magnified and exposed in a time of social upheaval.
We do know that in order to get a handle on the major damage we see occurring in real-time— and to inform that debate, it is first necessary to measure it.
The Provider Insurance Revenue Study
Purpose of the Study
This study aims to answer the question: What is the financial impact of the COVID-19 epidemic on US-based healthcare Providers?
Broader Implications of this Study
Social processes that impact the health of patients are also known as the social determinants of health (SDOH). These are the conditions in which people are born, grow, live, work and age 1 as well as the complex, interrelated social structures and economic systems that shape these conditions.2 These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. 1
The two most important SDOH are income and health security. In America the two are inseparably linked; that is, one impacts the other. Although a lot of study has gone into SDOH as social circumstances relate to individuals, little research has gone into what happens when healthcare Providers across an entire nation endure extreme financial stress.
Healthcare Providers across the United States have suffered unrecoverable financial losses during the COVID-19 epidemic. We hypothesize that healthcare Providers are experiencing ongoing losses for several reasons including due to state-ordered shutdowns. The study rationale also asserts that those Providers who deal with private insurance companies over the period are more likely to suffer financial losses at a higher rate than before the COVID-19-related State actions, adding to their financial distress. No matter what the reason, ultimately it is the patients who pay for these losses one way or another, most definitively making this financial shortfall a notable example of SDOH. Our objective is to carry out a pragmatic study that quantifies the financial losses of healthcare Providers due to the actions of profit-focused insurance companies during a national health emergency.
The ‘PIR’ Study Summarized
We are enrolling 100 healthcare Provider volunteers (n=100) from across the United States to help us evaluate and document the financial impact of COVID-19 on Physicians and other healthcare Providers. Our investigation will compare individual Physician revenues before and after the advent of the COVID-19 pandemic. We expect to be able to differentiate between revenues lost due to the COVID-19-driven business recession and revenues lost due to the manipulation of reimbursement processes by insurance companies. The inextricable linkage between Payer and Physician revenues suggests that Payer revenues are higher at the direct expense of Physicians, since both streams come from the same sources of funding. Our secondary objective is aimed at revealing the methods Payers use to retain more money.
Primary Outcome Measures :
Change in monthly income of healthcare Providers from baseline to 6, 9 and 12 months after the beginning of the COVID-related events. [ Time Frame: 12 months ]
Secondary Outcome Measures :
2. Differences in Accounts Receivable (AR) due to claim denials over 4 quarters: Differences in recoveries of AR. [ Time Frame: 12 months ]
This study is officially endorsed by the COVID-19 clinical trials series, University of California, Irvine and will be conducted from our offices at the Beall Center for Applied Innovation at University of California, Irvine, and registered with The Office of Behavioral and Social Sciences Research (OBSSR) (search: NCT04587245 ), which supports behavioral and social sciences research at the National Institutes of Health (NIH). The results will be published in a peer-reviewed journal.
If you are a Physician or a healthcare Provider who submits claims to private insurance companies, please consider enrolling in this important study. All data compiled for this study will be aggregated and used anonymously . HIPAA rules will apply to the handling of all data.
Your participation will go a long way to understanding where the financial losses are occurring for Physicians as well as the behaviors and practices of the insurance companies during our great national health emergency. Since some of the researchers in our group are MDs, we know that your time is precious. To that end, we have developed a study design that will take only a few minutes of your time over the course of the year.
Any questions you have should be addressed to 'firstname.lastname@example.org.'
To enroll in the study, please click on the following link.