Healthbridge MD, Luis da Silva

Private healthcare practices in the country have lost an estimated total of R9.1 bn in revenue since the beginning of the COVID-19 lockdown while a loss of another R2.8 bn is predicted for the rest of the year as patients volumes are expected to remain lower than normal and the November/December holiday period approaches.

This is according to Healthbridge MD, Luis da Silva. Speaking at a webinar organised by the Gauteng General Practitioners Collaboration (GGPC) Da Silva looked at the impact of the pandemic on the business of practices and measures doctors can implement to safeguard them against financial ruin.

Sharing weekly data collected by Healthbridge of 5000 practices representing around 8000 doctors across the country, Da Silva noted that although there has been a gradual increase in patient volumes since the introduction of lockdown Level 4, it is starting to ease off again with no hope in sight that they will increase to pre-COVID numbers.

Aggregated across all disciplines, patient numbers were at their lowest levels in April plummeting in some specialties to as low as 32% but gradually picking up after the implementation of Level 3 to an average of around 84% at the highest and then declining again.

In the first weeks of lockdown general surgeons and GPs saw their numbers dwindling to between 39% and 42%. Shortly after the introduction of level 3, the number of GP visits increased sharply to up to 90% of normal volumes but dropping off again to an average of 65% in the last few weeks. In the last week of level 5 lockdown, general surgeons saw a sharp increase in patient volumes of up to 87% and again in the first week of level 2 to 98% after most private hospitals resumed all elective surgeries. However, in level 3 and after the first week of level 2 the numbers started to taper off again to between 49% and 70% as COVID-19 hospital admissions increased and more beds had to be made available. Anaesthesiologists were similarly affected in the first few weeks with numbers dropping to as low as 32% but then picking up sharply during July and August to between 74% and 93% as the number of ICU admissions increased during the peak of the pandemic in the country.

Least affected were psychologists who have reached almost normal levels at around 97% after dropping to 56% in week 5 of the lockdown. Da Silva says this could be attributed to psychologists being the best equipped to utilise telehealth and the increase in patients suffering from mental problems such as anxiety and depression due to the devastating impact the pandemic is having on their lives and their livelihoods.

Apart from the direct impact of the pandemic on their practices, healthcare professionals are now facing another risk to their revenue as bad debt increases because of patients failing to settle their bills due to the financial hardships they experience. In addition, the intermittent closure of practices because of doctors and their staff becoming infected and exposure to positive patients continue to have a detrimental effect on the income of practices and their ability to resume normal operations.

“Although the measures implemented to contain the spread of the virus worked extremely well, the financial impact on practices is expected to continue as patients are still staying away because of fear of infection and the possibility of a second wave of infections,” Da Silva said.

The number of medical scheme patients, doctors are likely to see are also expected to decline as more and more people discontinue their membership or buy down due to financial pressures. According to Da Silva, medical schemes initially predicted a 4% contraction in membership but that it is likely to get much worse as the full economic implications will only start to hit the country in the next few months.

But says Da Silva all is not lost if practices follow a few practical steps to inoculate their practices against the fallout of the pandemic and recoup lost revenue. These include a much wider adoption of telehealth and digital solutions to expand patients’ access to care and streamline operations, stringent measures to curb the accumulation of bad debt and proactively engaging with chronic patients to ensure that they continue with their routine check-ups.

Da Silva pointed out that although virtual consultations have quadrupled in the lockdown period, the numbers are still extremely low compared to other countries such as the US and the UK, with virtual consultations only contributing to 2% of the total number of claims submitted.

Apart from allowing patients to regularly engage with their health providers without fear of infection, telehealth also have a number of additional advantages such as permitting more flexible consulting hours and allowing doctors to continue with consultations despite having to self-isolate after exposure to the virus.

Most medical schemes are now paying for virtual consults even though the rates are lower than for face-to-face engagements but says Da Silva, it still generates revenue that otherwise would have been lost.

To reduce bad debt, Da Silva urged practices to become more like pharmacies and submit claims in real time and ensure that patients settle outstanding amounts before leaving after a consultation.

“The impact of the pandemic on practices is real and will continue for some time to come but adopting actionable innovative strategies to mitigate risks and recoup revenues could safeguard the sustainability of practices,” Da Silva concluded.