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'Offices are closing everywhere' as Austin's private practices face revenue loss due to pandemic

Private medical practices are seeing fewer patients and taking more risks under coronavirus. (Emma Freer)
On Sunday night, Tom Banning received an email from a young solo practitioner working in New Braunfels whom he has known since she was in medical school.
"Tom," she wrote. "I am one of these practices that will need to start letting staff go (even though it goes against every fiber of my being, in not being able to financially support my staff during these difficult times). But as my volume has plummeted and virtual visits are not paid at the same rate, we are struggling to maintain financial viability."
Banning, CEO of the Austin-based Texas Academy of Family Physicians, said he is hearing from people constantly. On Monday morning, a community health center in Austin called him "literally begging for masks" for their staff, he said.
The coronavirus pandemic is causing a critical cash flow problem for physicians in private practices and clinical settings. Without the support of a corporate owner, many are worried about their financial viability as appointments are cancelled, elective procedures are postponed and insurance payments for telemedicine are negotiated for patients whose plans are not regulated by the state or federal government.
Banning said TAFP members are seeing a 50% to 70% decline in patient volume.
"When you're operating in a fee-for-service system, which we are, and your revenue is determined by volume, that's highly problematic for your ability to make payroll [and] pay your mortgage," he said.
Samantha Bray, a therapist and owner of Bray Counseling in Westlake, worries that existing patients may cancel appointments because of their own financial hardships as a result of this pandemic.
"I think that businesses across Austin are going to suffer and folks are probably not spending money on things that they feel are not necessities right now," she said.
Bray added that she is unsure if her four-person practice will qualify for small business assistance or other federal support.
According to a March 27 press release from the American Medical Association, the $2 trillion federal stimulus package includes a number of measures that could benefit physicians in private practice, including small business loans up to $10 million to help cover payroll and overhead costs for practices with 500 employees or fewer; $100 billion in direct support to practices, hospitals and other healthcare providers; and possible waivers for telehealth coverage requirements for new patients.
Dr. Linda Villarreal, chair of the Texas Medical Association, said assistance may be hard to access, given demand.
"I would love for President Trump to dial the [Small Business Administration] number and see how quickly he gets an answer," she said.
Physicians are facing a wide range of challenges as a result of the pandemic.
Those who provide what may currently be considered elective procedures—such as ear, nose and throat doctors, orthopedic surgeons, dentists and plastic surgeons—are facing low demand.
Family doctors and those specializing in internal medicine, on the other hand, are on the frontlines of the pandemic, Banning said.
"What's happening is almost criminal," he added. "These physicians are putting their physical health and their financial health on the line and we're treating them like this...There are going to be long-term consequences in burnout, morale and their ability to practice medicine."
These doctors and their staff are also at risk of contracting COVID-19, which could further affect their ability to work because of recommendations to self-quarantine for two weeks.
Without revenue, doctors may be unable to pay their bills or their staff, many of whom may not come into work without pay.
"So yes," Villarreal said. "Offices are closing everywhere."
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(Paxton Smith/Instagram)
Paxton Smith’s 2021 valedictory speech at Lake Highlands High School in Dallas wasn’t the same speech she had previously shared with school administrators. She dropped the approved speech and made a case for women’s reproductive rights after lawmakers passed the Texas "Heartbeat Bill.”
Her advocacy made news on NPR, YouTubeTV and in The Guardian. Just over a year later, the “war on (women’s) rights” she forewarned has come to a head as the U.S. Supreme Court voted Friday morning to overturn Roe v. Wade, ending constitutional protection for abortion access.
“It is up to the people to show up and show the courts and the politicians that we won’t sit back and let this happen,” Smith told Austonia Friday morning. “We will show up, we will fight back. Before, we were scared of them, now they should be scared of us.”
Now a University of Texas sophomore and abortion rights activist, 19-year-old Smith said she wanted to give the same speech in the “the most public way possible” to reach “as many people as possible who don't agree that I deserve this right.”
However, she says the response was “actually overwhelmingly positive” and supportive of her cause. According to a recent UT poll, 78% of Texas voters support abortion access in most cases.
The speech opened up further opportunities for activism: she advocated for reproductive rights at the International Forum on Human Rights in Geneva, interviewed with Variety magazine and spoke to tens of thousands at Austin’s Bans Off Our Bodies protest at the Texas Capitol in May.
Smith also serves on the board of directors for the Women’s Reproductive Rights Assistance Project, a national nonprofit organization that helps fund abortions or medication abortion—like Plan C pills—in all 50 states. Most recently, Smith has been attending protests in Washington, D.C. leading up to the ruling.
“This is land of the free. This is where you get to choose how you live your life,” Smith said. “Overturning Roe v. Wade violates everything that we have come to believe about what it means to live in this country. I think a lot of people aren't willing to accept that this is a human right that is most likely just going to be gone for over half of the country within the next couple of weeks.”
Bracing for the next steps, Smith gave some tips for supporters:
- Find a protest to attend.
- “I would say invite somebody to go to those protests with you, invite a couple of friends, invite people into the movement,” Smith said.
- Talk about the issue on social media—use the platform you have.
- “Have these kinds of conversations where people can just talk about their fears and then find ways to go and advocate for yourself,” Smith said.
- Volunteer at a nonprofit near you.
“I feel like a lot of the reason things have gotten as bad as they have within the abortion rights world is that people are not making a scene, not protesting, not putting the effort into ensuring that the government doesn't take away this right,” Smith said. “I want to emphasize that if you're not doing anything, don't expect the best scenario, expect the worst because that's the direction that we're going in.”
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(Council Member Chito Vela/Twitter)
The U.S. Supreme Court overturned Roe v. Wade, the landmark ruling that guaranteed a constitutional right to an abortion, Friday morning. Moments later, Austin City Council set a special meeting for next month to pass a resolution aimed at decriminalizing abortion.
The GRACE Act, which stands for guarding the right to abortion care for everyone, is a twofold plan submitted by council member Jose “Chito” Vela. It recommends that city funds shouldn’t be used to surveil, catalog, report or investigate abortions. It also recommends that police make investigating abortion their lowest priority.
Council Member Vanessa Fuentes, who co-sponsored the resolution along with council members Paige Ellis, Kathie Tovo and Mayor Steve Adler, said the importance of the GRACE Act cannot be overstated.
“By introducing this resolution during a special session, City Council is doubling down on fighting back for reproductive health,” Fuentes said. “Items like the GRACE Act will promote essential healthcare while enabling individuals to exercise their bodily freedom.”
The act takes an approach similar to when former council member Greg Casar moved to decriminalize the possession of small amounts of marijuana. Ultimately, state law doesn't allow city officials to order police chiefs to adopt specific enforcement policies so the resolution would be a request to Police Chief Joe Chacon. In May, Politico reported that Vela is having "ongoing conversations" with Chacon about the proposal.
Austonia contacted Attorney General Ken Paxton for comment on the GRACE Act but did not hear back by time of publication. On Friday, Paxton celebrated the overturning of Roe and announced an annual office holiday on June 24 in recognition of the high court's decision.
In a press release, Vela said the Texas state government has a history of overturning municipal protections of human rights. Thirty days after the Supreme Court’s ruling, Texas will ban all abortions, with exceptions only to save the life of a pregnant patient or prevent “substantial impairment of major bodily function.”
Still, Vela expressed hope for the GRACE Act’s longevity. Council’s special meeting on it is set for the week of July 18.
“We know this resolution is legally sound, and Austin is not alone in this fight,” Vela said. “We are working with several other cities who are equally horrified by the prospect of an abortion ban and want to do everything they can to protect their residents.”
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