Dr. Viraj Desai, owner of Swish Dental, has closed seven of her eight area locations due to the coronavirus pandemic. One remains open, for life-threatening emergencies only, in an attempt to keep local emergency rooms clear of non-coronavirus patients. With no revenue coming in, Dr. Desai has applied for federal small business assistance but worries because she is hearing nothing.

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The economic injury disaster loan, for which Dr. Desai applied, initially promised up to $2 million in assistance but now has an apparent cap of $15,000, which she said would barely cover Swish Dental's rent.

"We're not exactly sure we're going to receive it, how much we're going to receive. And it just seems like [the Small Business Administration has] tons of applications," she said.

Across Austin, private practices have seen a sharp drop in business because of a state-mandated moratorium on non-essential procedures and surgeries. According to the healthcare data firm Infinedi Analytics, patient visits are down 68% in Travis County, compared to 47% nationally.

"The problem … is a lot of the routine care and elective surgeries are pretty much on hold right now as we gear up and get ready for whenever this surge of patients is going to happen," said Dr. Jack Myers, a Temple-based physician and board member of the Texas chapter of the American College of Physicians.

The American Academy of Family Physicians, which represents 134,600 members, lobbied Congress to account for private practices in its $2 trillion stimulus package.

"If there is a private practice out there in the United States of America that is still seeing their full complement of patients, they're in violation of the federal and state mandates," AAFP President Gary LeRoy said. "So I don't know anyone who's not been touched by this."

On March 26, President Donald Trump signed into law the Cares Act, bipartisan emergency legislation that included $377 billion for small businesses. Last Friday, applications opened for a relief program included in the act—the Paycheck Protection Program—which allows small businesses like Swish Dental to apply for up to $10 million in forgivable loans so long as they don't lay off any employees or they rehire those who had been already.

Local private practices are waiting for this money to be disbursed, and some have questioned if the stimulus will be enough to prevent these businesses from going under.

Consulting firm Gist Healthcare reported April 1 that 61% of primary care clinicians are uncertain about their ability to remain open in four weeks and 19% are unsure if they will be forced to close permanently.

Some practices are already reducing costs.

"We are hearing about nurse practitioners who are losing jobs or being furloughed across the state," Texas Nurse Practitioners Board President Christy Blanco said.

Last week, dozens of professional organizations and state medical societies—including the American College of Physicians, the American Medical Association and the Texas Medical Association—wrote a letter to Health and Human Services Secretary Alex Azar requesting additional relief for private practices, beyond what was included in the Cares Act.

Specifically, the signatories asked the U.S. Department of Health and Human Services to provide one month of revenue to physicians, nurse practitioners and physician assistants caring for patients covered by Medicare or Medicaid "to account for financial losses and non-reimbursable expenses."

Some physicians are incurring expenses—such as staying in hotel rooms or renting apartments to avoid exposing their families to the coronavirus—that do not qualify for federal assistance under the Cares Act, per the letter.

"Who's going to recoup those expenses?" Dr. Myers asked.