Since its release, New York State’s proposed 2008–09 executive budget has garnered much debate. And while the next few months will see many parts of the budget modified or struck out, there is one section that we hope avoids the red pen: the budget’s crucial investment in primary and preventive care.
Primary care—the services that act as a general first point of consultation for patients—has long gone underinvested. Reimbursement rates, the funds that physicians and providers receive from public or private insurers for services provided, have gone unchanged for more than a decade, leading to a near exodus of primary care physicians to other states and specialty care.
The result is that only 17 of New York’s 62 counties have half of their physicians involved in primary care, the minimum amount called for by the American College of Physicians. The doctor shortage is perhaps most acute in the Adirondacks, where the Hudson Headwaters Health Network is one of a mere handful of primary care providers in a region more than twice the size of Rhode Island.
The administration’s “Doctors Across New York” initiative provides incentives for young doctors to join or create primary care practices in underserved areas of New York State. With fewer medical school graduates entering primary care, and even fewer deciding to practice in rural New York, this measure is an important step toward ensuring that all New Yorkers have access to primary care services.
Equally important is the budget’s focus on increasing reimbursement rates for primary care services. Most primary care providers are reimbursed on a per-visit basis. That is, insurers (including public insurance like Medicaid) determine set rates for types of visits and reimburse the physician based on these rates, most of which are woefully low. There is even some evidence that the reimbursement rates are often less than what it costs to render services, causing providers to lose money on each visit and seek outside grants to fill the gaps. Although the executive budget will continue to reimburse providers on a “pay-per-visit” basis (something that should be revisited in the future), it takes important steps toward varying rates based on the intensity of the care, giving Medicaid reimbursement a shot of common sense.
The challenge is to improve primary care reimbursement in a thoughtful, practical manner that does not compromise the critically important funding New York’s hospitals rely on to deliver high-quality patient care. The New York State Health Foundation looks forward to working with all relevant stakeholders to make that challenge a reality.
The dramatic importance of this cannot be overlooked. In recent weeks, we learned of a new medical breakthrough that may allow Type 2 diabetes patients to have stomach-shrinking surgery leading to, for some, full remission of the deadly disease. The discovery could mean a path to remission for millions of Americans with this deadly disease. At the same time, it reminds us that there are preventive steps that are just as important, markedly more effective, and considerably cheaper.
Type 2 diabetes is one of the few deadly diseases that we know can be prevented with proper nutrition, diet, and preventive care. And though this new surgical procedure may help some lose weight, many will find themselves quickly returning to their original weight and the diabetes that often comes with it.
Medical costs continue to soar because we have placed far too much emphasis on expensive medical treatments rather than more effective, noninvasive, and preventive measures like nutrition and diet—which receive scarce attention and far too little funding. The emphasis on bolstering New York State’s primary care infrastructure will play a critical role in ensuring that we can prevent the increase in development of preventable and costly chronic illnesses like diabetes. The best treatment, after all, is to prevent these conditions from appearing in the first place.
James R. Knickman, President and CEO
