The Role of COVID-19 in Transitioning to a Better Pediatric Payment Model

Abstract

* Abbreviations: COVID-19 — : coronavirus disease 2019 PMPM — : per member per month The coronavirus disease 2019 (COVID-19) pandemic has quickly impacted health care systems and especially primary care pediatricians. Although fortunately cases of severe COVID-19 and the associated multisystem inflammatory syndrome in children have been rare, the disruptions caused by the COVID-19 pandemic have exposed the financial vulnerability of independent pediatric practices that rely primarily on fee-for-service revenue. Social distancing and stay-at-home advisories have led to the cancellation of routine well-child and follow-up visits for many children and young adults nationwide, as evidenced by the steep drop in childhood vaccines since March.1 Furthermore, social distancing has led to a significant reduction in the incidence of common infections and playground and sports injuries, further diminishing the need for office visits.2 And, even when children do become ill or injured, parents fear exposing their children to infection by bringing them for care during the pandemic. Yet although children have been relatively spared from the brunt of direct health effects of COVID-19, social isolation and lack of school attendance have placed them at increased risk for mental health disorders, missed screenings for lead poisoning, poor nutrition and/or exercise habits, and undetected child abuse, which are situations that call for a strengthening of the primary care infrastructure to assure children’s health needs are met. In our own affiliated primary care network, in-person visits initially fell by ∼75% after statewide … Address correspondence to Michael A. Lee, MD, MBA, Department of Accountable Care and Clinical Integration, Boston Children’s Hospital, 300 Longwood Ave, Mailstop 3196, Boston, MA 02115. E-mail: michael.lee2{at}childrens.harvard.edu