Office of Primary Care and Area Health Education Centers (AHEC) Program

Anne Morris, M.D., associate professor of family medicine

(SEPTEMBER 16, 2024) Anne Morris, M.D., associate professor of family medicine, and Toby Sadkin, M.D., clinical assistant professor of family medicine, commented to VT Digger for a story on Vermont primary care doctors’ contention that low Medicare reimbursement rates make running a primary care practice challenging and results in less access.

Sadkin is a primary care doctor from St. Albans and the chair of Primary Care Health Partners, a group of privately owned primary care offices with locations throughout New York and Vermont. She told reporters on Monday that in some of the group’s practices, Medicare and Medicaid patients account for roughly 60 percent of their total patients.

“Unlike other businesses, we cannot simply increase our prices when our costs go up,” Sadkin said. “When we agree to participate in Medicare and Medicaid, we agree to accept their payments. We agreed to participate even with low reimbursement rates, because we are passionate about taking the best care of our patients.”

Eventually, doctors say, if the numbers don’t add up anymore, practices may have to turn away Medicare and Medicaid patients, or close their doors altogether. And the supply of primary care doctors in Vermont is not keeping up with demand, according to Morris, a primary care doctor in Milton and the residency director of the University of Vermont’s Department of Family Medicine.

“Unfortunately, there are many headwinds working against us,” Morris said Monday. “Physicians are aging faster than we can train new clinicians. High student loan debt and high paperwork burdens make primary care look unattractive to students. And on top of that, low and declining payments for primary care make keeping an office open difficult.”

According to Morris, what that translates to for Vermonters is: “It’s hard for everyone to find a new primary care clinician, but even harder if you have Medicare.”

The downstream effect of Vermonters not being able to attain primary care, Morris and Sadkin said, is that Vermonters are increasingly relying on urgent care or emergency room visits to get acute medical attention. Oftentimes, Morris said, the acute medical situations could have been treated earlier, more effectively and more affordably if only a patient had received preventative care.

“This is a problem that we see every day,” Morris said. “It’s definitely something that we are seeing happen more and more frequently. Our urgent cares and our ERs are very capable of reaching out to primary care offices and saying, ‘This is someone that absolutely needs to be seen soon for follow up.’ But the reality is, is that our practices are full, and the access to that care is often—if it needs to be within 24 hours, often can’t be met for several days beyond that.”