The Primary Care Development Corporation analyzes New York’s current reimbursement rate structure for the primary care sector, particularly for providers who deliver primary and preventive care in underserved communities, and offers principles and recommendations for reforming that system.

Inadequate reimbursement rates from private insurers threaten the future of many of New York State’s community health centers (CHCs) and their ability to continue serving all patients, concludes a new study, Improving Commercial Reimbursement for Health Centers: Case Studies and Recommendations for New York, released by the Community Health Care Association of New York State (CHCANYS), and funded by CHCANYS and the RCHN Community Health Foundation.  CHCs receive significantly lower reimbursement rates from private insurers compared with those from public payers including Medicaid and Medicare.  Commercial reimbursement rates are far below the actual costs of care.

New York State has embarked on a substantial effort to restructure its health care system as a result of rapidly escalating health care expenditures, especially with respect to Medicaid expenditures for institutional health care. But it is impossible to alter these high cost health expenditures without strengthening and expanding the primary care foundation on which New York’s health system rests.

The Primary Care Imperative
Several features make primary care effective, and these features can be embodied in a range of service delivery models such as private group practices and hospital and freestanding clinic services. Health centers and hospital clinics represent particularly important sources of primary health care for populations at risk for medical underservice.

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Primary Care Medicine, the field of
medicine practiced by primary care
physicians, is critical to the provision, coordination and management of
cost-effective, timely, high-quality
health care. In New York, as in much
of the United States, recent health
care trends, health policy legislation
and career choices of physicians
away from primary care bode poorly
for the future health care needs of its
citizens. This report examines those
trends, including their antecedents
and  consequences, and offers possible solutions for what is fast becoming
a health care crisis.

As of 2003 there were 293,701 primary care physicians (PCPs) in the United States, constituting 37.3% of the physician work force, 12.7% fewer than are considered necessary for the health care needs of the population. In New York State, only 17 of 62 counties have the requisite 50% of their physicians involved in primary care, and 7 counties have more than 2000 patients per single primary care provider, a grossly inadequate ratio akin to that found in some developing nations.

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New York State currently is engaged in a long-await­ed policy discussion about the size and shape of its health care system. This is particularly meaningful now because resources are or will be available to sup­port a restructuring of that system. A primary cata­lyst of this effort is the Commission on Health Care Facilities in the 21st Century. The Commission’s final report, due at the end of 2006, will include specific recommendations on hospital and long-term care facility restructuring and closures. These rec­ommendations—and a new Governor’s response to them—will have significant implications for New York City.

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A major gap in the Commission’s charge is primary care, which represents the majority of community-based health services before and after hospitalization. To that end, the Primary Care Development Corpo­ration (PCDC) and the New York City Health and Hospitals Corporation (HHC) conducted an analy­sis of primary care physician availability and popula­tion vulnerability in New York City.

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New York State has over 19 million people residing in 62 counties. Because of the large populations and land areas of most counties, county-level data frequently mask significant differences between communities. Since there are 1600 ZIP codes in New York State, ZIP code data are more effective in revealing needs at the community level, and should be used wherever available. This report is an initial effort to characterize ZIP codes by their level of primary care need. The report was prepared by the New York State Area Health Education Center (AHEC) System Data Resource Center and is offered as a resource to those working to plan and strengthen the primary care delivery system in New York State.

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