Report Shows Poor Patients Cost Doctors

Primary care physicians lose money each time they treat poor or uninsured patients, a new report has found.

The report, to be released today by the Primary Care Development Corporation, shows that doctors lose between $28 and $226 for each patient visit, largely because of low Medicaid reimbursement.

The report also documents widely different compensation to doctors and hospitals for the same services provided. Voluntary hospitals lose $226 from every primary care visit, while the city's public hospital system, the Health and Hospitals Corporation, loses $132.75 for every primary care visit. Federally Qualified Health Centers lose $27.58, and hospital-affiliated FQHCs lose $71.95, while HHC-affiliated diagnostic and treatment centers lose $111.51.

Part of the problem is that Medicaid reimbursement rates have not changed since 1995, according to the PCDC's executive director, Ronda Kotelchuck.

Ms. Kotelchuck said the irrational reimbursement scale is causing a primary care shortage. "Do you think a young person coming out of medical school says, 'I want to go into primary care instead of a specialty that pays really well?' It really does threaten to erode what we have at a moment in time when what we really need to do is expand this sector," she said.

Earlier this year, the city comptroller, William Thompson Jr., published his own report that showed disparities in hospitalization and mortality rates based on income.

The report also found that the poorest neighborhoods had the fewest primary care doctors.