I think using GO FUND ME is ridiculous, but wanted to post this article because small health care practices face some pretty uncertain times.

FEW WEEKS AGO, I received an unsettling email. The staff at my daughter’s pediatrician’s office — a family-run private practice in Brooklyn that serves more than 3,800 patients — was shifting to part time. The practice had applied for the Small Business Administration’s Paycheck Protection Program, meant to help small businesses weather the economic turmoil brought by the Covid-19 pandemic. But the money wasn’t coming, at least in the initial round of funding.

“To be honest and frank, we are exhausted,” wrote Matteo Trisolini, the operations director at South Slope Pediatrics. The pandemic had taken its toll on office morale and “we have seen a loss of revenue that came with fewer visits and still high bills to pay.”

The next day, Trisolini sent another email. At the urging of some of the other parents whose children are with the practice, he had set up two GoFundMe campaigns: one to help support the staff and another to help cover appointments and bills for families who had lost their jobs — and their health insurance — thanks to the pandemic. I donated. It felt dystopian, to say the least. How had this happened?

“I never thought I’d have to do that as a medical office. Never,” Hai Cao, the owner and founding doctor at South Slope Pediatrics — and my daughter’s pediatrician — told me later, in an interview over Zoom.


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It’s not news that New York City has been hard hit with Covid-19. Some of the disease’s effects on the city’s health care system have been immediate and obvious: overflowing emergency rooms, shortages of protective gear, makeshift morgues, and confusing and changing rules over childbirth and other necessary non-Covid-19 hospital visits. Across the world, similar patterns have unfolded as SARS-CoV-2, the coronavirus that causes the disease, has established and spread.

But what was happening at South Slope Pediatrics felt different — a signal of another health care crisis waiting for us somewhere in the murky post-Covid-19 future. What did it mean for all the other small practices, not just in Brooklyn, but everywhere?

Medical crowdfunding isn’t new, of course. GoFundMe, the most popular platform for raising money for health care, says it hosts more than 250,000 medical campaigns every year, mostly for people who need help paying astronomical medical bills. But now that the Covid-19 pandemic is here, there are also new types of medical fundraisers — for everything from masks and intensive care equipment to food and coffee for frontline hospital staff. Then there’s the new wave of campaigns for small offices like South Slope Pediatrics. They’re happening across the country, from primary care physicians in New York to pediatricians in California to family doctors in Texas to optometrists in Maine to dentists in Colorado.

When I asked Thomas D’Aunno, professor of management at New York University’s Wagner Graduate School of Public Service, about medical offices turning to crowdfunding, he said: “In my 40-year career in this field, this is a first. Without a doubt.”

What was happening at South Slope Pediatrics felt different — a signal of another health care crisis waiting for us somewhere in the murky post-Covid-19 future.

That Covid-19 is putting small medical practices, which are more financially vulnerable than consolidated practices and those at big hospitals, in such a precarious position doesn’t bode well for the future of health care in the United States. “I think the use of GoFundMe to pay for medical care is obscene and signifies how deeply broken our medical system is,” said Stephanie Woolhandler, a distinguished professor in public health and health policy at City University of New York, Hunter College. “It’s broken if patients have to use it, and it’s broken if doctors have to use it.”

Many more small practices are struggling behind the scenes. And these small practices — already on the ropes thanks to economic pressures that pre-date the pandemic — play a key role in our health care system. They are often in the neighborhoods that they serve, which means they are easier to access on a day-to-day basis. They typically provide primary care — they are the first doctors we see when we are sick and the doctors who monitor us on a regular basis to make sure we stay healthy. Small practices also provide a level of personal interaction that so often feels missing in modern medicine — and in modern life in general. Before the pandemic, I’d walk by South Slope Pediatrics on my way to the gym; I’d sometimes see the staff in the neighborhood on their lunch breaks. And Cao and Trisolini, who are married, are adoptive parents like me. During office visits, Cao weaves anecdotes about their own adoption milestones as he asks about my daughter’s development, gently checks her over, and answers my endless lists of questions.

Losing that wouldn’t just be a problem for my family’s health. It would give me the same ineffable sensation as when I see a favorite local restaurant shuttered, or a quirky shop replaced with a bank — a piece of a community gone forever.

IN A RECENT ARTICLE in the Atlantic, journalist Derek Thompson described a David-versus-Goliath battle between big and small businesses in America. Covid-19, he suggested, has not been an equalizing force. “It’s a toxin for underdogs,” he wrote, “and a steroid for many giants.”

“Who will emerge intact from the pandemic purgatory, and who will not?” Thompson asked. He was squinting at our future commercial landscape, particularly for cities. The outlook isn’t great. Leaving aside grocery stores, only a third of small businesses expect they’ll still exist if the pandemic lasts six months, according to a working paper published by the National Bureau of Economic Research in April. Thompson argues that, at least in the short term, cities will get more boring and homogenous as mom-and-pop shops and small restaurants are replaced by big companies and chains.

Thompson doesn’t address health care, but his point applies there, too. The data from the NBER report aren’t so granular that they cover small pediatrician offices or family practices. But the report does include survey data from 449 small businesses that relate to health care, less than half of whom said they’ll be in business if the Covid-19 crisis lasts four months. For six months, the number drops to 35 percent. And according to a briefing given to Capitol Hill staffers by the American Academy of Family Physicians and others at the end of last month, about 11 percent of primary care offices will close in the next few weeks without financial assistance.

The situation at South Slope Pediatrics illustrates why small practices are at risk. Cao and Trisolini opened the office in 2012 with 275 patients. “It’s a pop-and-pop shop,” Trisolini told me. Cao, who had been in a larger practice, was seeking more personal relationships with his patients, while Trisolini, who previously worked in photography and fashion, wanted to work in a field that felt more compatible with parenthood. The goal was never to create a big business or even a chain of pediatrician offices, they said, but to run a small, community-based practice.


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Today, the practice has 3,843 patients and 13 employees on payroll, including four doctors, three nurses, and administrative staff. The monthly overhead is between $200,000 and $300,000 for key expenses like payroll, rent, and a supply of vaccines. “Living in New York is not easy, it’s not cheap,” Cao said. “We pay higher rent and we have to pay our employees more because they pay higher rent.”

In order to pay that rent, South Slope Pediatrics relies on patient visits. The money comes from insurance companies and co-pays, and it depends on those in-person encounters. Before the Covid-19 pandemic began, Cao’s office typically saw about 80 patients a day — a mix of well visits and vaccinations and sick visits — and aimed to keep patients no more than five minutes in the waiting room. At the end of the typical year, the practice is able to put aside about two weeks of total operating expenses as a cushion.

In March, the office had to rethink day-to-day operations. They shifted all well-visits that didn’t involve vaccinations to telemedicine. They cleared toys and books from the waiting room. They scheduled necessary appointments so no one was waiting for even a minute, allowing just one family to check in at a time. Cao and Trisolini say they did this, in part, to make the office safer for newborns and infants who must come in person for vaccinations and check-ups. For newborns, this has been particularly important. Because of Covid-19, New York hospitals are often discharging new parents and babies just 24 hours after delivery. (In order to catch illnesses and other problems, the American Academy of Pediatrics normally recommends a hospital stay of 48 hours for vaginal births and 96 hours for cesarean sections.)

Despite these safety measures, after Covid-19 struck, “we saw a storm of cancellations, a storm of no shows,” Trisolini told me. Appointments dropped to between 15 and 20 per day. Some newborns and infants did arrive for vaccinations, but those don’t bring in much money because the office doesn’t mark up the shots. The office was able to schedule some telemedicine visits, but insurance companies don’t always pay as much for those. And many families temporarily left the city, which means they won’t be in even for necessary well visits. (I’m one of them. In order to get help from family with childcare while my spouse and I work from home, among other things, we left Brooklyn on March 12 — before the travel restrictions — for upstate New York. We thought it would be short-term, but we’re still here and had to make appointments for wellness checks and vaccines with a local pediatrician.)
The practice applied for the Paycheck Protection Program as soon as possible, but on April 17, Cao received an email from his bank explaining that the initial round of funding had already been exhausted. Cao and Trisolini told me that they later learned the bank hadn’t had time to even send their application. “That is when I thought, this is how it ends,” Trisolini said. That led to the email about the practice cutting hours as well as the patient-led push for the GoFundMe campaigns.

The story is the same even for practices that have been around much longer. Bent Tree Family Physicians — which has a GoFundMe campaign that a patient launched when the office’s initial Paycheck Protection Program application was declined — opened in Frisco, Texas in 1987. Today, the practice has 85 employees and serves 30,000 people across North Texas. But Guy Culpepper, a family physician and the practice’s founder, said their overhead is between $400,000 and $500,000 a month. By the end of the year, he added, they have enough to cover just one month of operations for the following year and “we always need a line of credit.”

“It’s not that different from someone running a mom-and-pop restaurant or busting their ass as an electrician or plumber,” Culpepper said. “The only difference is that the younger doctors are also still paying off $500,000 of debt.”

“We need to change the model at a national level,” he added.

SMALL PRIVATE PRACTICES like Cao’s and Culpepper’s have been disappearing from the medical landscape for decades. During that time, they have sold to larger hospital systems or private equity groups, or have joined together to form consolidated practices, said D’Aunno. Bigger groups have more negotiating power with the insurance companies, which means they can bring in more money and the margins are better. And they also have access to other resources and infrastructure, including social workers and support from big information technology and billing departments.

While larger groups are also under financial strain right now — there are even GoFundMe campaigns for staff from major hospital systems, which have seen massive furloughs — they tend to have deeper pockets, which means they have a better chance of coming out of the pandemic more or less intact. “They can borrow money, or have large reserves,” Woolhandler said. Some have multi-billion-dollar endowments. Many hospital systems — particularly those with a high number of patients who are privately insured and don’t rely too heavily on Medicare and Medicaid — have surpluses thanks to lucrative procedures such as elective surgeries and diagnostic tests. Some of those hospitals are doing so well, they’re eyeing private practices even now. Culpepper told me that several approached him about selling his practice after the GoFundMe campaign went up, like “vultures circling over us.”

Meanwhile, the private offices popping up on GoFundMe — pediatricians, family practices, even dentists and optometrists — provide basic care that simply doesn’t bring in much money. But that care is vital. Specialties like these “are on the front lines of keeping people healthy,” said D’Aunno.

LINK: https://undark.org/2020/05/09/...19-doctors-gofundme/

Well then, how about a GoFundMe for the hookers?

Yanno, they need money until they can get back on their back. (groaner)
.

Why have they not been treating their regular patients? The experience I've had recently is medical practices voluntarily deciding to follow restrictive guidelines from their professional associations like the AMA and ADA. They are the definition of essential services, so maybe they shouldn't have bought into the hype and panic that is destroying their business.

One Dentist close to my office is capitalizing on all this hype. He has an office worker posted at the door to ask questions and take a temperature. A release is then signed and a 7 dollar Covid surcharge is added to the visit.

The physicians that I see have done nothing to discourage in person visits. If they had I would be finding new physicians. Sadly most Americans get their health care advice from social media. Patients are more scared to visit their physician than the grocery store. Two of our local hospitals have ZERO covid 19 patients.

I get an email almost every other day from my doctor telling me that they have open appointment times to be booked the same day. It used to be that I would wait 3-4 days for an appointment, but they are seeing very few patients.

Part of the reason for my local doctor's office is they require you to go to a separate location (2 blocks away) to sign in, take a temperature and answer a questionnaire before you can proceed to the doctors office. pain in the arse for me.

quote:

I think using GO FUND ME is ridiculous, but wanted to post this article because small health care practices face some pretty uncertain times.

It IS ridiculous.

quote:

Part of the reason for my local doctor's office is they require you to go to a separate location (2 blocks away) to sign in, take a temperature and answer a questionnaire before you can proceed to the doctors office. pain in the arse for me

^^^^^
I agree. It sounds like some sort of corporate policy.

The funny thing is, the local hospital was calling for all kinds of donations. Local heroes, doing God's work.

My problem is that when I went there with kidney stones, it cost me eighty thousand dollars. My wife had a gall bladder removed, for some ungodly sum. A couple of tumors in there, costly. Kids over the years with baseballs to orbital sockets, motorcycle mishaps, broken digits. Nobody offered me a break. When the bills kept pouring in, unseen and unknown until months, sometimes nearly a year later, they came after me right away, threats, collections, pay it all, we want it now.

Nobody was saintly at the time, and nobody worried about giving me a break. You weren't complaining when you came in, writhing in pain. We helped you. Now pay. Mortgage your house if you must, but pay us.

Now it's go-fund-me? Can't make the payments on the six million dollar house and large two-engine boat in the drive?

I understand the small practice has a high office cost, most likely outstanding student debt from an expensive education, malpractice insurance that accounts for half their cost, and so on. I get it. But seriously. Go-fund-me would have worked for my kidney stones, three operations, and stent too, or would it have been a good place to start the samaritan process of reciprocity?

I get injured, jailed, or killed bringing those N95 masks to the hospital from China, Korea, and points abroad, or get sick and quarantined in Shanghai as some of our associates have, it works both ways...or they just take now, and once back on their feet, bill the living shit out of me for a bandaid and a stitch, and then send me to collections?

Seems fair.

^^^^^^^^^^^
Hey I hate hospitals as much if not more than you do. I have been ripped off as much if not more than you have. Professional courtesy ended years ago and was replaced with Coporate Healthcare.

quote:

Originally posted by ZSMICHAEL:
One Dentist close to my office is capitalizing on all this hype. He has an office worker posted at the door to ask questions and take a temperature. A release is then signed and a 7 dollar Covid surcharge is added to the visit.

Surcharge my ass. I'd tell that dentist exactly where he could put that. And it wouldn't be an oral procedure

quote:

Originally posted by sns3guppy:
The funny thing is, the local hospital was calling for all kinds of donations. Local heroes, doing God's work.

My problem is that when I went there with kidney stones, it cost me eighty thousand dollars. My wife had a gall bladder removed, for some ungodly sum. A couple of tumors in there, costly. Kids over the years with baseballs to orbital sockets, motorcycle mishaps, broken digits. Nobody offered me a break. When the bills kept pouring in, unseen and unknown until months, sometimes nearly a year later, they came after me right away, threats, collections, pay it all, we want it now.

Nobody was saintly at the time, and nobody worried about giving me a break. You weren't complaining when you came in, writhing in pain. We helped you. Now pay. Mortgage your house if you must, but pay us.

Now it's go-fund-me? Can't make the payments on the six million dollar house and large two-engine boat in the drive?

I understand the small practice has a high office cost, most likely outstanding student debt from an expensive education, malpractice insurance that accounts for half their cost, and so on. I get it. But seriously. Go-fund-me would have worked for my kidney stones, three operations, and stent too, or would it have been a good place to start the samaritan process of reciprocity?

I get injured, jailed, or killed bringing those N95 masks to the hospital from China, Korea, and points abroad, or get sick and quarantined in Shanghai as some of our associates have, it works both ways...or they just take now, and once back on their feet, bill the living shit out of me for a bandaid and a stitch, and then send me to collections?

Seems fair.

I’m with you, I have zero sympathy for hospitals. I’ll admit though, I really like my primary care doctor. He’s the best doctor I’ve found, takes his time with me, reviews my previous visits before seeing me and he listens to what I tell him. I’m pretty sure he lives within his means just looking at the guy, but if he needed help I’d make some visits to his office whether I needed them or not. Plus his last name is Hooker, who else can tell their wife that they are going to see the Hooker and she doesn’t care?

That being said I suppose these doctors never had much schooling on finance and accounting during their education. I realize people never counted on a virus to disrupt our economy but maybe they should listen to Dave Ramsey and have 6 months of living expenses saved up. I think that principal applies to business too but I doubt many business owners had much saved up for a rainy day. Two months of business expenses saved up would have gone a long way.

Remember, not so many weeks ago we were sternly warned that the ‘rona would “overload” our medical system and there wouldn’t be enough doctors, nurses, or hospital space.

What is that thing about telling a lie often enough?

I've seen a mixed response in Pennsylvania. My cardiologist (part of the hospital group of physicians) was closed for almost two months while my family practice guy (independently owned) split his staff and remained open. Dentists were another story: at the beginning, they could only remain open if they had negative-pressure operatories, something that not even the Pennsylvania dental schools have. Many, including my oral surgeon, closed. Now that they are allowed to open, it appears (from several things I've read--don't know yet if this is really true) that only non-aerosolizing procedures may be used (except in an emergency), which apears to prohibit use of high-speed drills. I should add that Wolf and Levine made the original decision with no consultation of dentists, dental schools, the PaDA or the ADA.

quote:

I should add that Wolf and Levine made the original decision with no consultation of dentists, dental schools, the PaDA or the ADA.

^^^^^^^
That is frightening. Here in Mississippi the decision was quick and from the Dental Board. Talk about overstepping boundaries.

quote:

Originally posted by jljones:
Remember, not so many weeks ago we were sternly warned that the ‘rona would “overload” our medical system and there wouldn’t be enough doctors, nurses, or hospital space.

What is that thing about telling a lie often enough?

Depends where you were. Some areas were hit harder than others, and were entirely overwhelmed.

My primary care doc has been open and I’ve seen her twice since shutdown. The lobby of the building they take your temp and give you a mask to wear if you don’t have one and ask you all kinds of probing questions before they let you on the elevator. Also hand sanitizer stations everywhere but that was there before hand.

Just got an email that my dentist is open starting Monday and they will call me to reschedule my cleaning that was due in April but postponed

The overwhelming turned out to be sort of, underwhelming.
U.S. Field Hospitals Stand Down, Most Without Treating Any COVID-19 Patients

I um... er.. lets say I know many many people who work at "the sky is falling" central, number one on the list.

To put a number on it

In January my pediatric practice had over 1100 visits

In April we didn’t clear 600

A lot of Peds is well care, and people don’t want to go to the doctor right now because they’re worried they will be exposed to coronavirus


Just to put a sigforum face on the article



Oh, and we haven’t started a GoFundMe page

I don’t know what to say here about the gofundme.

Kevbo, I feel your pain- we are a small private eye clinic, and far more sanitized, monitored, and controlled than the grocery or Home Depot, but folks are flocking to those places and putting off eye care due to fears of getting the virus from being at the clinic. It makes NO sense.

Yup, I know we all need food, but no one at the grocery is checking to see where you last were, if you’ve a got a fever, chill, or traveled recently, and you’re touching all kinds of shit! They’ve only just recently started monitoring numbers of people entering, whereas we screen, limit numbers, and lock doors if we have to. The safety measures most clinics have put in place make any type of small health clinic one of the safest places to go at this time. And yes, we’ve seen about a 90% loss in business. It is heartbreaking after the decades of work we’ve put in. But GoFundMe? I don’t think so.

quote:

Originally posted by cas:
The overwhelming turned out to be sort of, underwhelming.
U.S. Field Hospitals Stand Down, Most Without Treating Any COVID-19 Patients

I um... er.. lets say I know many many people who work at "the sky is falling" central, number one on the list.

I keep hearing “depends on where you live” but all these field hospitals were unused. But, I guess if you ORDER nursing homes to take people with the virus, knowing that it is lethal to people that live in nursing homes, you do have a higher rate of hospitalization because you caused it.

You really have to wonder if the claim is true to begin with, and if it is was it caused by mismanagement by a totalitarian governor? With all the lying going on, I’m skeptical.