Clinical Trial Details
— Status: Recruiting
Administrative data
| NCT number |
NCT04587245 |
| Other study ID # |
PIRStudy |
| Secondary ID |
|
| Status |
Recruiting |
| Phase |
|
| First received |
|
| Last updated |
|
| Start date |
October 1, 2020 |
| Est. completion date |
October 15, 2022 |
Study information
| Verified date |
October 2021 |
| Source |
ND Sciences, LLC |
| Contact |
Henry Broeska, PhD |
| Phone |
949-332-9638 |
| Email |
hbroeska0[@]saddleback.edu |
| Is FDA regulated |
No |
| Health authority |
|
| Study type |
Observational
|
Clinical Trial Summary
The investigators are enrolling 100 healthcare Provider volunteers (n=100) from across the
United States to help to evaluate and document the financial impact of COVID-19 on Physicians
and other healthcare Providers. This investigation will compare individual Physician revenues
before and after the advent of the COVID-19 pandemic. The investigators 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. The secondary objective is aimed at revealing the methods Payers use to retain more
money.
Description:
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.
The investigators 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.
