The loss of in-person visits coupled with higher-than-normal expenses threatens physician practice viability, the American Medical Association says.

Physician practice viability is under threat as physicians continue to see fewer patients in-person, according to a new report from the American Medical Association (AMA).

The report based on findings from a survey of 3,500 physicians found that 81 percent of physicians said revenue was still lower than pre-pandemic levels by August 2020. Furthermore, one in five physicians reported revenue declines of 50 percent or more, although the average drop in revenue was 32 percent.

Physicians are seeing significantly fewer patients, with 70 percent of physicians reporting that they were still providing fewer total visits at the time of the survey compared to pre-pandemic levels. In fact, average total visits decreased from 101 to 72 per week even though telehealth use exploded during the pandemic.

Telehealth visits were nearly five times higher per week at the height of the pandemic compared to the pre-pandemic period, the report showed. And by the end of the survey period in August, weekly telehealth visits were still almost three times higher.

However, 81 percent of physicians said they were still providing fewer in-person visits compared to the pre-pandemic period, with the average total of in-person visits falling from 95 to 57 percent week.

The loss of in-person care revenue coupled with rising expense costs, especially for personal protective equipment, threatens physician practice viability, according to the AMA.

“Physician practices continue to be under significant financial stress due to reductions in patient volume and revenue, in addition to higher expenses for supplies that are scarce for some physicians,” Susan R. Bailey, MD, president of the AMA, said in a statement. “More economic relief is needed now from Congress as some medical practices contemplate the brink of viability, particularly smaller practices that are facing a difficult road to recovery.”

The government has provided financial aid to physician practices, most notably through the CARES Act’s $175 billion Provider Relief Fund.

The vast majority of practice owners found the federal assistance beneficial, with 80 percent of physicians to the survey saying CARES Act funding was very or extremely helpful.

Even more helpful to practice owners, though, was the Small Business Administration’s Paycheck Protection Program, which offered forgivable loans to small business owners to promote employee retention during the pandemic. Healthcare providers were among the top receivers of the loans, according to federal data from the summer.

About 88 percent of physicians described the federal aid from the Paycheck Protection Program as very or extremely helpful, the report showed.

Additionally, 71 percent of physicians said that a program that advanced Medicare reimbursement to providers at the start of the COVID-19 public health emergency was equally as helpful. Physicians, however, were more likely to describe the program as just “somewhat” helpful compared to the other federal assistance efforts (24 percent versus 18 percent for CARES Act funding and 12 percent for Paycheck Protection Program).

The initial repayment terms for the advanced Medicare payments were unfavorable for struggling physician practices. However, a continuing resolution bill passed in September offered longer repayment periods, a lower interest rate, and less claim recoupment for the first year of repayment.

The changes to repayment were praised by industry stakeholders. But economic challenges remain, indicating a need for further relief from the government, the AMA said in the survey report.

“It is clear the COVID-19 pandemic continues to have a negative impact on physician practices, both in terms of decreased revenue and increased costs,” according to the report. “While initial federal financial relief programs were helpful to practices that applied, it appears the road to recovery, particularly for smaller physician-owned practices, remains difficult and more economic relief is needed.”

More recently, the AMA rebuked suggestions from within the administration that physicians have overcounted COVID-19 patients or lied to claim more revenue.

Today is Election Day and results could reignite Congress’ efforts to pass another stimulus package or more healthcare-related relief.