When primary care physician Dr. Kate Atkinson goes to reunions, she’s usually met with this question from her peers: “Are you still practicing?”
And to their surprise, she still is, despite intense shortages within a field that faces escalating rates of burnout. As these trends continue, her colleagues are leaving for direct primary care, aesthetics or functional medicine — areas where they can bypass insurance companies and pursue cash reimbursements directly from patients.
Atkinson, however, continues to see patients at Atkinson Family Practice, with offices in Northampton and Amherst. She continues to struggle with longtime problems primary care doctors face, including a lack of funding and mounting insurance paperwork, while many patients struggle to get an appointment at all.
Primary care is crucial, Atkinson added, since it offers preventative care rather than treatment after health problems have already set in — which also helps lower the overall cost of healthcare.
After decades of advocacy, Atkinson sees a glimmer of hope in the form of a sprawling bill that recently passed in the House of Representatives. The legislation would significantly boost investment in primary care, though it’s unclear if the funding will hold as House and Senate negotiators must now reconcile the two chambers’ packages.
In the meantime, Atkinson is calling on residents to keep pushing for the legislation until it can be signed into law.
House Speaker Ron Mariano was lukewarm on the Senate’s primary care bill (S.3141), saying senators passed their version “without any idea of how much it was going to cost.” But the bill (H.5618), passed 158-0 on July 30, incorporates two hallmarks of the Senate approach: an aggregate primary care spending target and a new payment model moving away from a fee-for-service model.
The House envisions the state gradually spending 15% of all healthcare dollars on primary care by 2036; the Senate wants to hit that mark by 2030. Currently, just 6.6% of commercial healthcare spending goes to primary care, according to the Center for Health Information & Analysis.
“The bill before us aims to address this problem. It does so incrementally, increasing the expenditures to 9% in 2030, 12% in 2033 and 15% ultimately in 2036,” said Rep. Greg Schwartz, a primary care physician, during his inaugural House floor speech. “It’s a significant increase in the primary care portion … done at a pace that gives our provider networks and insurance payers enough time to adjust their contracts to achieve these goals smoothly.”
Unlike the Senate version, the House bill sets only an aggregate spending goal rather than requiring individual healthcare entities to hit the target. Mariano said the longer timeline and allowances for safety-net versus teaching hospitals made the approach more workable.
“We make allowances for the different situations that different hospitals are in,” Mariano said, adding, “We put some options in there that we will count for participation … that aren’t financial, like hiring an extra nurse to keep your health center open another couple hours.”
The bill directs the Health Policy Commission to require primary care investment commitments from healthcare entities exceeding the state’s cost growth benchmark, exempting smaller physician groups — those with patient panels of 15,000 or fewer, or units earning less than $25 million in annual net patient revenue.
The legislation also requires commercial insurers to reimburse community health centers at MassHealth rates, mandates coverage of mobile integrated health services, and includes provisions on the use of artificial intelligence in insurance reviews, pharmacy benefit manager oversight and drug rebates.
“We are typically under-reimbursed by commercial insurers. We serve everybody, but not everybody pays the same. … This would bring everyone to the same playing field,” said Arley Hoynoski, chief financial officer for the Community Health Center of Franklin County, which operates clinics in Greenfield, Orange and Turners Falls. “This would increase revenues for us significantly.”
Hoynoski said it’s unclear at this time exactly how much the bill would increase revenues for the Community Health Center of Franklin County, and if there would be any increased reporting requirements for the center, but she is hopeful the bill will make a positive difference for health centers and the healthcare system as a whole.
Implementation would not happen overnight, Hoynoski continued, but over time, these extra funds would allow the center to invest in hiring more clinicians or operating more vans to help patients get to their appointments, to name a few possibilities that would allow the center to better meet patients’ healthcare needs.
Echoing Atkinson, Hoynoski said primary care is preventive care, and allows patients to have their concerns and issues addressed before they get worse and require more expensive treatments and care options.
“We never want to stop someone from going to the emergency room or the hospital if they need to … but investing in primary care saves the system money and saves people money,” Hoynoski said. “Spending money on primary care prevents needing to spend more money on more expensive hospital visits in the future.”
Atkinson, a doctor in her 60s, said she likely won’t be practicing long enough to see the funding from the legislation be fully realized — but she still sees the fight as worth it. She said the bill would mean more staff working in primary care offices, as fewer physicians leave the field or choose to retire early due to burnout. For patients, that means shorter wait times and increased availability.
“This bill would move us toward that 15% target gradually, over 10 years, while also cutting the prior authorization red tape that eats up hours of every PCP’s week, funding population and healthcare management work that currently goes unpaid,” Atkinson said, “and putting real money into workforce recruitment.”
Madison Schofield contributed reporting.
