The looming closure of Anchor Medical Associates has highlighted a critical dilemma facing Rhode Island’s health system: Tens of thousands of patients are in need of primary care, but medical practices are struggling to recruit doctors needed to care for them.
On April 4, Anchor Medical, a primary care physician group, announced it was closing its three locations in Lincoln, Providence and Warwick by June 30. This is expected to leave 25,000 Rhode Islanders without a primary care provider.
There are already an estimated 100,000 to 200,000 Rhode Islanders without a primary care provider, so adding another 25,000 people to that list will only strain the state’s already fragile health care system, said Dr. Caroline Richardson, chair of family medicine at Brown University's Warren Alpert Medical School.
“It’s a disaster,” said Richardson, who also practices part time.
Dr. Thomas Bledsoe, an internist for Brown Medicine, says his practice was already getting 10 to 20 calls a day from people looking for a provider. After Anchor announced its plans to close, the practice had to put out an automated message saying they were not taking more patients.
"Lots of people – whether they're sick currently or healthy and afraid they’re going to get sick – are really nervous and stressed,” Bledsoe said.
In response to Anchor’s impending closure, Gov. Daniel J. McKee has called on the R.I. Executive Office of Health and Human Services to work with R.I. Department of Health to find organizations that can take on patients and providers. These discussions “remain active,” McKee spokesperson Olivia DaRocha said in a statement.
Anchor has also created a web page with dozens of practices that are taking new patients.
But while some physician offices can absorb some of Anchor’s patients, there needs to be a longer-term solution, said Dr. Elizabeth Lange, board president of Care Transformation Collaborative Rhode Island, a nonprofit working to enhance primary care across the state.
“It doesn’t mean we can [absorb patients] comfortably,” Lange said. “It just means we are passionate about taking good care of Rhode Island citizens.”
This is especially true because the state’s Medicaid reimbursement rates don’t cover the cost of care – a situation that can make it more costly for a medical office to take on more patients, adding to the financial strain.
For its part, Blue Cross & Blue Shield of Rhode Island said on April 16 that it would be making changes to "improve financial stability and predictability for primary care practices to support their efforts to hire staff and expand patient access."
The changes include increasing payments to primary care providers by a total of $40 million over the next three years by raising commercial fully insured reimbursement rates for primary care doctors by 15%, starting July 1.
To reduce the administrative burden for primary care doctors, the insurer said it is also eliminating prior-authorization requirements for 65% of medical services, treatments or medications for both commercial and Medicare plans. And it is offering a new contract option that provides practices with advance monthly payments.
Anchor cited its struggle to hire replacements for health care providers who have retired – made even more challenging by rising costs and stagnant reimbursement rates – as the main reason for closing.
Many other health care facilities in Rhode Island are facing similar issues.
That’s why, Bledsoe said, if some of Anchor’s 22 doctors, nurse practitioners and physician assistants want to find a job in Rhode Island, they probably could, but it might not be easy.
With about one-third of the state’s population relying on Medicaid, some medical offices may not be in a financial position to hire additional health care providers at a salary competitive with surrounding states, said Howard Dulude, president of the Hospital Association of Rhode Island.
“I don't think there's any place in health care in this state that isn't facing this challenge right now,” Dulude said.
For example, Care New England Health System loses $13.8 million each year on expenses to support its practice of 78 primary care providers, CEO and President Dr. Michael Wagner said at PBN’s Health Care Summit on April 2.
At the summit, Wagner said he had been approached recently about adding 20 to 30 more providers from a medical office that was going out of business – Wagner didn’t name the practice at the time but was likely referring to Anchor Medical. He said the answer was “no” because CNE couldn’t afford more losses associated with primary care.
“The point is that primary care is unsustainable because we're not paying it to the value that it creates,” Wagner said during a panel discussion at the summit. The best solution would be to increase Medicaid reimbursement rates, he said. “That's the bottom line.”
