ACP to Congress: Health Care Reform Must Ensure Supply of Primary Care Physicians

Abstract

A letter was sent by the American College of Physicians (ACP) in January 2010 to key legislators urging them to ensure that the final health care reform bill includes provisions to support the primary care workforce. “Recent studies show that the U.S. faces a shortage of more than 40,000 primary care physicians, even before taking into account increased demand for primary care associated with increased coverage,” said ACP President Dr Joseph W. Stubbs, MD, FACP, in the letter. The letter noted that any legislation must ensure that there would be enough primary care provisions to provide adequate access to care for the >30 million additional Americans who may soon have affordable coverage, as well as those who already have coverage. Specifically, the ACP requested that the final bill increase Medicaid and Medicare payments to primary care physicians. It noted studies showing that low levels of reimbursement for primary care, especially relative to other specialties, are a principal reason why physicians are not choosing to enter primary care. Under both bills, Medicaid will be expanded to cover millions more Americans, but many of them will not be able to find a primary care doctor if low reimbursement rates continue to make it impossible for primary care doctors to accept more Medicaid patients, the letter warned. The ACP urged support for a provision in the House bill to increase Medicaid payments to equal Medicare rates within four years. Both bills have provisions to increase Medicare primary care payments. The ACP recommended that the final agreement incorporate the Senate's 10% primary care bonus, but apply it more broadly to primary care services and physicians as proposed by the House, many of whom would be excluded under the Senate's more restrictive language. The letter also urged expansion of pilot testing and implementation of Patient-Centered Medical Homes. Both bills have provisions to expand testing and implementation of medical homes in both Medicare and Medicaid, but only the House has specific funding for 2 Medicare medical home pilots. Finally, the ACP recommended increased support for primary care training programs, including providing mandatory increased funding for the National Health Service Corps and Title VII primary care training programs.