Financial carrot eyed to revitalize primary care

Yahoo

13-05-2025

BOSTON (SHNS) – A parade of primary care physicians pleaded with lawmakers Monday to devote new funding toward the sector, warning that staff shortages and long waits for appointments will worsen without action.
Building on years of alarming reports about gaps in care, doctors and reform supporters urged lawmakers to craft a baseline spending target and to overhaul payment processes.
State watchdogs have already cautioned that Boston has some of the longest wait times for new patient physicals in the country and that Massachusetts has a comparably low share of physicians working in primary care. Several veteran doctors on Monday offered anecdotes of their own.
Dr. Katherine Atkinson, a family doctor based in western Massachusetts, said she struggles to recruit new physicians to her practice even when medical students voice an enthusiasm for primary care.
'They always come and are really excited by what we do, and they say, 'This is what I want to do.' And then a year later, I get a heartbreaking email that says, 'Dr. Kate, I ran the numbers, and I cannot afford to do primary care. I can make five times as much as a cardiologist,'' Atkinson told the Health Care Financing Committee.
'I'm begging you: please pass this or something like this. Do not study it again. I have been testifying for over a decade as things have gotten worse and worse and worse, and we're really at a cliff,' she added.
A pair of bills before the committee Monday (H 1370 and S 867) would move toward new payment models for primary care while quantifying the specific share of health care spending that must go toward primary care (12% of total health care expenditures in the Senate bill, at least 15% in the House bill).
Reaching those investment targets while controlling overall health care spending could spell painful changes for others in the health care system.
Rep. Richard Haggerty, a Woburn Democrat who filed the House proposal, warned of a 'crisis [that] is making it almost impossible to find a primary care physician in our commonwealth in a reasonable amount of time.'
'The idea is straightforward: if we invest more in keeping people healthy, we can avoid the much higher cost of treating them when they get sick,' he said of his legislation.
Some physicians have argued that primary care offers too little pay and too much frustration to attract staff compared to other specialized medical fields. A state report published in January found the primary care workforce here is aging and that the share of physicians in direct patient care is dropping.
Primary care doctors at Mass General Brigham are moving to join a union. While that unfolds, hospital leaders at MGB announced Monday they would invest nearly $400 million in primary care enhancements, the Boston Globe reported.
Tackling problems in primary care has been a topic of debate on Beacon Hill for years, but elected officials have not been able to agree on a path forward.
Former Gov. Charlie Baker twice proposed legislation (2019 and 2022) that would have required providers and insurers to increase what they spend on primary and behavioral health care, but lawmakers did not embrace either measure.
A lobbyist representing health insurers told lawmakers Monday her group is 'directionally supportive of the provisions in the bill to increase investments and expenditures for primary care.'
Sarah Chiaramida, senior vice president and general counsel at the Massachusetts Association of Health Plans, described the Senate version of the bill authored by committee co-chair Sen. Cindy Friedman as the 'right framework.'
'Primary care is the backbone of our health care delivery system, and MAHP supports provisions aimed at increasing expenditures as an important first step to reforming the way we pay for and deliver health care,' Chiaramida said. 'However, it's critical that increased investments in primary care be within the cost growth benchmark and not add to overall health care costs, which is a critical point that is reflected in [the Senate version of the bill] as health care affordability remains a significant research concern. As such, any requirement to increase funding for primary care must be coupled with offsets to other areas of spending to ensure that the overall cost of care does not increase unsustainably in place.'
Chiaramida called on lawmakers to give the Health Policy Commission authority to 'strictly enforce these requirements.'
Gov. Maura Healey said in January that she would order more resources to be directed to 'the front lines' of primary care, adding that she wants 'to build a whole army of primary care providers to be out there across our state.'
During Monday's hearing, co-chair Rep. John Lawn asked longtime physician and former Massachusetts Medical Society President Dr. Alan Goroll what he views as the 'number-one reason' many medical students are not choosing to go into primary care.
'Let me use a military analogy,' Goroll answered. 'You're very patriotic person. You'd like to serve your country. You want to be sure that you have the tools, the technology, the teamwork, the resources and the respect, and that we have your back. Primary care doctors do not feel they have any of that.'
'They are not dummies,' he added about medical students. 'They look at this and they say it's underresourced, the payment system is counterproductive to having time to spend with patients, the prestige is low and the future is dim as they build skyscrapers for cancer and heart disease, stuff for people to come from overseas. They see the resources being put in other places.'
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