Arkansas Clinics Losing Both Patients, Patience


Arkansas Clinics Losing Both Patients, Patience
“There’s only so much that you can sustain without folding. I’ve been able to weather the storm, but had it not been for the [first] PPP, well, we could have gone under.” - Scott Winston, owner of the Winston Clinic in Sheridan

Without money from the second round of the Paycheck Protection Program, Dr. Scott Winston of Sheridan doesn’t know if his independent primary care practice will stay open.

“There’s only so much that you can sustain without folding,” said Winston, who owns the Winston Clinic, which has seven providers and 32 employees, making it the largest clinic in Grant County. “I’ve been able to weather the storm, but had it not been for the [first] PPP, well, we could have gone under.”

The Winston Clinic received a PPP loan of about $300,000 in April as patients stayed away. Winston said last week that he plans to apply for another PPP loan.

Other physicians who operate independent primary care practices are also struggling, said Miranda Morris, the executive director of the Arkansas market for Aledade Inc. of Bethesda, Maryland, which provides services to primary care physicians and covers 110 locations in Arkansas.

“Since COVID arrived in Arkansas, primary care has been the other front line,” helping keep hospitals from being overwhelmed, Morris said.

“These independent primary care doctors, they don’t have a safety net the way the hospitals” and their clinics do, she said. “Their margins are very thin.”

But some financial help is on the way. Last week, small businesses could start applying for PPP loans. Congress approved a $900 billion stimulus package in December that included restarting the PPP with about $285 billion in funding.

Winston said he’s also waiting for the COVID-19 vaccines to be widely distributed. “The clinic will see an improved financial situation when patients feel comfortable coming back to the clinic and not feeling they are being exposed to the virus,” he said. “Hopefully, it will make a big difference and we’ll get back on the projected growth that we’ve done over the last 30 years.”

At the beginning of 2020, the clinic was coming off its best financial year. But then COVID-19 cases started to emerge in March in Arkansas.

As patients avoided hospitals and clinics, the Winston Clinic saw its patient revenue fall 21% in March, 23% in April and 33% in May compared with the same months in 2019.

From January through November, the clinic’s revenue was off 18% from the same period in 2019, Winston said.

“We can never recover that lost revenue,” he said. As an independent primary care practice, the clinic isn’t a nonprofit or tax supported, like several Arkansas hospitals are. “We are supported solely by the patients that we see,” he said.

In 2019, the clinic had about 20,000 patient visits, and in 2020, that number was estimated to be down 25%-30%.

To recoup some of its lost revenue, the clinic started in late March offering telemedicine services. “But we weren’t able to do labs, weren’t able to do X-rays, injections, all the ancillary things that might have added to that” revenue, Winston said.

In addition, the clinic also had to deal with members of its staff testing positive for COVID. At one time or another, three of its providers and six members of its support staff tested positive for the coronavirus and had to be isolated, Winston said.

Another issue for primary care clinics? Patients who have lost their jobs during the pandemic, leaving them without insurance coverage. Arkansas Works, the Medicaid expansion plan originally called the private option, has seen its enrollment numbers climb from 249,087 people on Jan. 1, 2020, to 300,772 on Dec. 1.

While some hospitals laid off nurses and other employees during the early days of the pandemic because of low patient volume, the Winston Clinic didn’t, said Winston, who graduated from Ross University School of Medicine in Bridgetown, Barbados, in 1983. Winston returned to his hometown in 1990, after serving five years with the U.S. Air Force as a flight surgeon, and opened the clinic.

“I didn’t lay anybody off. I didn’t cut back on anybody’s hours,” he said. “We just sucked it up.”