New Jersey Primary Care Report Has National Implications

The report, which was published by the New Jersey Health Care Quality Institute, was authored by more than a dozen experts.

A recently published report raises alarm about a primary care physician shortage in New Jersey and calls for the adoption of advanced primary care in The Garden State.

There is a shortage of primary care physicians across the country. The recent report shows that the shortage is not limited to rural areas.

A co-author of the report, which was published by the New Jersey Health Care Quality Institute, says the primary care physician shortage is widespread in New Jersey.

"All of New Jersey has had a shortage of primary care physicians, particularly family physicians and general internists. The report focuses on adult medicine, where we have the biggest shortage of primary care physicians," says Mary Campagnolo, MD, MBA, medical director of value-based programs and payer contracts at Virtua Health's Virtua Medical Group, a board member of the New Jersey Health Care Quality Institute, and a primary care physician.

She cited data from the American Board of Family Medicine, which tracks how many family physicians there are in the states for every 100,000-resident population. "New Jersey and Connecticut have the lowest concentration of family physicians at about 17 per 100,000. Many other states have 50 family physicians per 100,000 of population, so we are understaffed," Campagnolo says.

RWJBarnabas Health, New Jersey's largest integrated healthcare delivery system, is experiencing a shortage of primary care physicians, says Andy Anderson, MD, MBA, chief medical and chief quality officer at the health system.

"Currently, we are actively recruiting between 30 and 40 open positions for primary care physicians," he says. "Over the past five years, we have been trying to recruit the primary care workforce that we need for the future."

One of the main drivers of the primary care physician shortage in New Jersey is low reimbursement rates, the report says. "New Jersey's primary care spending as a percent of total health spending is one of the lowest in the country. … Fee-for-service payment rates for primary care are also low compared to other states. N.J. Medicaid pays primary care rates that are only about 50% of Medicare rates. Commercial primary care payment rates in New Jersey are on average 93% of Medicare rates compared with the U.S. average of 120% of Medicare," the report says.

Reimbursement rates for primary care physicians are problematic in New Jersey and at the national level, Anderson says.

"It has gotten a little bit better over the past five years—there has been an incremental increase in reimbursement for primary care, but it is not at the level it needs to be to influence physicians to go into primary care and to build out the workforce that we need for the future," he says.

The low reimbursement rates drive many primary care physicians who are trained in New Jersey to move to other states. Virtua Health works to provide competitive salaries and benefits to retain primary care physician trainees, Campagnolo says.

"We regularly assess the market rates in the Delaware Valley," she says. "Then we try to pay the median salary or higher. That helps to attract and retain primary care physicians. We have a good benefits package that is not always available to primary care physicians in private practices. We have good medical insurance coverage. We have a good retirement account. These strategies have helped us retain our trainees."

RWJBarnabas has pursued multiple strategies to retain its primary care physician trainees, Anderson says.

"We are trying to retain trainees through financial incentives and through partnerships with high-performing practices," he says. "We also have a model called the patient-centered medical home. In that model, the physician is the captain of the ship, but there are other health professionals in the model such as social workers, nutritionists, dieticians, and nurses who are part of providing a comprehensive environment for patient care. That type of a model is attractive for physicians because it is a team-based model."

Campagnolo says chief medical officers in New Jersey and across the country should be concerned about primary care physician shortages.

"If you are the chief medical officer of a health system that has multiple services, the referral source for those services is the primary care physicians. So, if you do not have primary care physicians, you do not have the ability to get patients to any of the other services," she says.

Promoting advanced primary care

The report calls for support of advanced primary care in New Jersey.

The National Academies of Sciences, Engineering, and Medicine (NASEM) define advanced primary care as integrated, accessible, and equitable healthcare provided by interprofessional teams that are focused on most of the health and wellness needs of individuals. Advanced primary care includes preventive care, management of chronic conditions, and a longitudinal perspective on patient health and well-being.

Anderson says RWJBarnabas' patient-centered medical home model for primary care is similar to the advanced primary care approach.

"We are practicing advanced primary care in the patient-centered medical home model of care," he says. "We have a team-based approach to primary care. We have physicians working with other health professionals to provide services focused on prevention, wellness, and chronic disease management. It is a good model in terms of providing better access, better support services, and better continuity for patients. It also provides more expertise in the primary care setting because everyone is working to the top of their license. For example, if you have a dietary expert, they really understand the field and can counsel patients at a high level."

The report makes three recommendations to support advanced primary care in New Jersey:

• The state should raise Medicaid FFS primary care payment rates to the level of Medicare and it should direct Medicaid managed care organizations to also pay Medicare rates for primary care.
   
• The state should take an active role in developing and encouraging advanced primary care in New Jersey.
   
• The state should report annually on primary care spending as a percent of total healthcare spending and on the use of alternative payment models that promote value-based care.