Gov. Daniel J. McKee’s new multipronged plan to shore up the state’s sinking primary care system has some in the industry questioning whether it goes far enough.
McKee’s six-part strategy includes accelerating a primary care Medicaid reimbursement rate review; requiring commercial health insurers to increase funding for reimbursements; strengthening fiscal oversight of the state’s health care system; reducing red tape by easing prior authorization requirements; providing $5 million in grants to help primary care practices hire new providers; and expanding the primary care student loan forgiveness program.
But while health care leaders say they appreciate that McKee is trying to address the shortage of doctors, they’re not exactly enthusiastic about some of the proposals.
“Our experience in the field tells us that nothing short of foundational increases in reimbursement rates – across all providers, from hospitals to private practices to health centers – will address the crisis,” Howard Dulude, interim president of the Hospital Association of Rhode Island, said in a statement.
One part of McKee’s plan – requiring health care facilities such as large physician groups to submit quarterly financial reports – raised eyebrows.
The intention is to allow the state to monitor entities for risk of failure, officials said. The proposal follows the announcement by primary care group Anchor Medical Associates that it would close in June, leaving about 25,000 people without a doctor.
But Dr. David Gellis, CEO of primary care practice Arches Rhode Island PC, said such a requirement might have an unintended consequence: creating even more paperwork for doctors who say they’re facing burnout from excessive forms, documentation and authorizations.
Stacy Paterno, Rhode Island Medical Society executive vice president, says she’s heard similar concerns from doctor groups , and there are questions about which practices would be required to submit reports.
“There are a lot of unknowns about it,” Paterno said.
And while Paterno applauded McKee’s plan to cut by 20% the number of cases needing prior authorization from insurers as a way to reduce the administrative tasks of health care providers, she said the medical society wants the reduction to go further, citing bills before the General Assembly that would eliminate prior authorizations with some exceptions.
Also getting mixed reactions: McKee’s plan to allocate $200,000 to the Health Professional Loan Repayment Program – specifically for primary care providers and pediatricians – marking the first time the state has allocated general revenue to the program since 2008.
Paterno said the program can fund up to four graduates and the federal government provides up to $1 million that the state must match. But Dr. Thomas Warcup, chief medical officer of the Rhode Island Primary Care Physicians Corp., said the loan forgiveness program is a “prudent policy too but fails to confront the deeper, systemic underinvestment in primary care infrastructure.”
McKee also plans to file a budget amendment to move up the timeline for a reimbursement rate review by the R.I. Office of the Health Insurance Commissioner by one year. McKee’s plan also includes requiring commercial insurers to double per-member spending by 2029. Primary care professionals say these amendments are helpful, but the only way to ease the state’s crisis is to increase reimbursement rates quickly.
“We don’t need more case studies or audits to know primary care is struggling,” Gellis said.
Laura Hart, spokesperson for McKee, said changes to Medicaid reimbursement rates must be based on “trusted data” and that biennial rate reviews are set by law. Also, a more informed approach can prevent Rhode Islanders from shouldering tax increases from raises to Medicaid reimbursement, she said.
