Worcester Business Journal

8 Worcester Business Journal | May 27, 2024 | wbjournal.com PHOTO | EDD COTE Of PRIMARY concern e crises in the healthcare industry are hitting primary care doctors hard, as policymakers work to bring multiple fixes to fruition BY NORMAN BELL Special to WBJ I n late April, pharmacy giant Walgreens waved the white flag on its bold experiment in bringing frontline medical care into its retail spaces. VillageMD primary care offices in Shrewsbury, Marlborough, and Fram- ingham were among almost 200 across the country to shut their doors aer Walgreens acknowledged its $5-billion bet in 2021 was yielding multi-bil- lion-dollar operating losses in 2023. "It's not entirely surprising," said Dr. Joahd Toure, senior vice president at UMass Memorial Health in Worcester. Bringing care closer to the patient is a recurring theme in health care, Toure said, pointing to UMass Memorial Health's own efforts to extend coverage into suburban villages and beyond. Bringing a national brand name like Walgreens to the fight was a noble effort. But primary care is a tough nut to crack, Toure said. ere aren't enough doctors to go around, operating costs are rising, and margins are slim. VillageMD still has about 500 clinics in operation in 26 markets apart from the Walgreens experiment. Points of friction A host of factors are putting a squeeze on primary care practices: - Doctors complain rising paperwork demands are increasing costs and de- creasing their ability to see patients; - Pay inequities and burnout are driving out primary care physicians; - Insurer demands for prior approval on procedures, referrals, testing, and prescriptions is crippling; - Baby Boomer doctors are retiring just as an increase in aging patients is hitting exam rooms. Collectively, the situation demands new approaches. Federal regulators and legislators are pushing an increased role for telemedi- cine as one possible answer. Telemedicine came of age during COVID, Toure said. "Now the toothpaste is out of the tube," he said. Medicare's decision to cover telemedicine visits for primary and behavioral health is a game-changer. Efforts are underway in Congress to move telemedicine from a temporary measure to a permanent part of the solution. Still, telemedicine has its limits, Toure said. Annual wellness visits need to be hands-on, for example. Routine endocrinology visits that involve eval- uating tests results, by contrast, seem a good fit for telemedicine. Certainly, a combination of in -person and online visits could be both effective and patient-friendly, he said. Future of telemedicine Telemedicine offers the prospect of doctors seeing patients outside the normal 8-to-5 office schedule, possibly by employing time-shiing techniques beyond state borders. He pointed to radiology, where imaging is read and evaluated in places like the Philippines and India, allowing work to continue while patients and doctors sleep in Cen- tral Massachusetts. Could telemedicine eventually allow shiing weekend on-call coverage from overworked primary care doctors to perhaps a regional call center, restoring some work-life balance? Regulators in states like Arizona, Oregon, Florida, and Texas have cleared the way to erasing borders in licensing. Asked if healthcare could follow banking into a technology trap, Toure demurred. "I'm not a banker, and I don't fully understand the business model," he said. Looking at his smartphone, he acknowl- edged technology has made it easy to manage money without visiting a bank. e banking industry went through a robust building period as it sought to bring services closer to customers only to find tech made branches redundant. e blend of telemedicine and wear- able technology constantly monitoring Dr. Joahd Toure, senior vice president of UMass Memorial Health, sees telemedicine as one way to improve the lives of primary care providers.

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