Will Primary Care Physicians Receive a Stimulus Package of their Own?

Jeffrey Harris, MD, president of the American College of Physicians, last week sent an interesting letter to prospective Secretary of Health and Human Services Tom Daschle. In it, he proposed that any “stimulus package” enacted in president-elect Barack Obama’s administration should “provide a ‘down payment’ on expanding health insurance coverage and delivery system reforms to reverse a growing shortage of primary care physicians.”

Harris recommended that any such package, at a minimum, include “direct financial assistance and access to affordable coverage for individuals who will lose their jobs and with them, their health insurance” and “a temporary increase in federal matching funds to states for Medicaid and SCHIP to be used to maintain current levels of Medicaid and SCHIP enrollment and benefits.” This is in keeping with the ACP’s longstanding commitment to healthcare reform to improve access to care for the uninsured.

Such assistance might also serve as something of a financial hedge for primary care physicians in tough economic times; providing funds to ensure covered individuals remain covered might mean fewer individuals who decide to delay seeking treatment or altogether forego visits to their primary care provider. With many states already facing severe budget shortfalls, any increase in the ranks of the uninsured due to unemployment will bring with it increased demand for Medicaid and other services. Bolstering Medicaid and SCHIP might also help primary care physicians in the end; however meager Medicaid reimbursement rates are, it’s better than nothing (though I’m sure some providers will disagree).

More provocatively, the letter also calls for the stimulus package to provide “targeted increases in Medicare payments for primary care physicians as a first step toward reversing a growing and potentially cataclysmic primary care workforce shortage.” Specifically, the ACP recommends a 10% Medicare bonus payment for the next 18 months “for all services provided by primary care physicians,” to be identified by Medicare, which would specify “a percentage threshold of claims for office visits and other services representative of a primary care practice” in order to determine who is eligible to collect the bonus payments.

This would “stabilize funding for primary care practices, especially smaller ones, which are an essential part of the safety net that people rely on for their care, especially in tough economic times. Without funding to stabilize primary care practices, many will go under and have to close.”