Specialty Physicians Weigh in on the State of Practice After COVID-19

The negative impact of the COVID-19 pandemic on specialty medical practices may lift by the start of next month, according to a new report issued by the market research company Spherix Global Insights.

"Our frontline healthcare leaders are scared, worried, and frustrated. Collectively, they estimate it being eight to nine weeks before things begin to improve and 83 percent of those surveyed last week (April 1) expect things to get worse in the next two weeks. In the words of one neurologist, "(My greatest concern is) that it will linger on to some degree for much of the year and dramatically and permanently affect people's livelihoods, relationships, and dreams," according to a statement issued by Spherix.

The company surveyed 252 rheumatologists, dermatologists, gastroenterologists, nephrologists and neurologists early this month findng that office visits are down by at least 80 percent, despite the adoption of telemedicine. Doctors, the report said, have had challenges with telemedicine and are still unclear about reimbursement policies for the use of telemedicine in place of in-office visits. "Though telemedicine consults have seen successive increases each week, it is not coming close to bridging the gap, and some specialties are having a more difficult time than others," Spherix stated.

The drop in cases has placed financial strain on office-based practices, particularly for dermatologists and gastroenterologists who rely heavily on elective procedures. Many practices have furloughed or staff or laid off works altogehter. If the lockdown and pandemic continues for another two months, some private practices may not survive. "Those in smaller practices are most concerned," the report stated.

While 23 percent of physicians belive the stimulus package will help their practice, more than one-third anticipate little to no impact from government assistance and the majority of physicians have ranked President Trump's handling of the crisis "low satisfaction."

"Drugs associated with being more targeted regarding their immunosuppression and generally considered as having favorable safety profiles may come off the least scathed: Amgen's Otezla for psoriasis and psoriatic arthritis (PsA) and Takeda's Entyvio for inflammatory bowel disease (IBD), though the latter will be counter-balanced by tempered use of infusion products. For most leading brands in the autoimmune space, there have been minimal issues with the supply chain, the exceptions being hydroxychloroquine (84% of rheumatologists report issues) and Genentech's Actemra (34% of rheumatologists report issues). Products that require administration by a healthcare professional, such as Sun Dermatology's Ilumya for psoriasis, also face a challenging scenario," the report stated.

Drug suppliers, such as AbbVie, have been in frequent communication with dermatology, gastroenterology and rheumatology specialists. "It seems that AbbVie in particular is attempting to thwart any launch setbacks for their next generation JAK inhibitor (Rinvoq), as the company was listed the most frequently by rheumatologists as continuing to provide samples via mail and engage in e-detailing platforms."

"Nephrologists have been a bit more buffered than other specialists with regard to patient volume decreases, as their dialysis population continues to require thrice weekly treatment to survive. However, their patient population – immunosuppressed kidney transplant patients, elderly dialysis patients receiving care in group settings, and a patient base with chronic kidney disease that typically has multiple other co-morbidities – is associated with a significantly higher risk of COVID-19 complications. Over the past two weeks, nephrologists increasingly reported having action plans in place for dealing with a COVID-19 outbreak at a dialysis unit; the vast majority are prepared. Most of those surveyed give high satisfaction ratings to dialysis organizations, such as Fresenius and DaVita, and the American Society of Nephrology, for their communication around COVID-19. Only 22% feel that the pharmaceutical industry is providing a high level of support/communication, and more than half say that increased samples, largely to help bridge patients with financial hardship, would be appreciated."

Approximatley half of neurologists are now starting fewer multiple sclerosis patients on their first disease-modifying therapy (DMT) or switching patients to new treatments, compared to prior to the COVID-19 outbreak. "While concerns related to immunosuppression are definitely a factor, access to infusion centers and delayed scheduling of next doses may also be playing an increasing role in the decreased use, as three out of five neurologists indicate that at least some patients are having difficulty getting their Ocrevus treatments (compared to only 28% for a high-efficacy oral DMT like Novartis' Gilenya)."