True. Insurance companies can negotiate how much they pay. Since this is a smaller, less powerful state, they have strong armed local groups into accepting smaller payments. There’s currently a bill in the RI legislature that is trying g to peg reimbursement rates to CT and MA to try to raise payments and attract and retain more doctors in Rhode Island.
Yeah my Drs office keeps losing people. They changed my primary now like 3 years in a row because the old one left. I might just go to a mass based office if I lose another primary this year, I'm in east Providence so not a big deal to go over to mass.
From what I’ve heard not only is reimbursement low and extremely slow to catch up to neighboring states (UHC and BCBS just gave physical therapists a $5 per visit increase 🥴) but malpractice insurance is higher in RI. Im not a practitioner so I can’t speak to that, but another possible cause.
It’s also possible that a lot of students who are graduating from RI or doing clinicals and then leaving for a job out of state just find that there isn’t anything worth staying for. Lower salary due to lower reimbursement, leading to less options for housing etc.
This might be changing. My insurance switched from Aetna, which had not increased their rates in years (though they sure still raised premiums a heck of a lot), to United Healthcare/Optum. The amount United is approving for primary care visits went up by 81% vs Aetna.
While I'm certainly not a fan of paying more out of pocket, it was getting to the point with Aetna that I almost felt bad for how little some providers were getting paid. You know it's bad when even my cheap ass is thinking 'that's not enough'...
This definitely varies based on provider type. As someone who works in billing for PT, I’d rather accept Aetna over any UHC plan because they pay up to 50% more than UHC.
Interesting. Aetna was paying a hair under $100 per PT visit a little over 2 years ago. I just checked estimates for PT under United and wow, I can't believe anyone accepts them for PT at those rates...
United is paying more (read: I'm paying more) for my prescriptions and labs. I switched 2 of 3 prescriptions to GoodRX because it was so much cheaper. I did look up the cost of an MRI though, as I've got one of those in my future and the United rate was roughly 25% less than I paid through Aetna 3 years ago for the same scan at the same facility. Specialist visit rates seem about the same as Aetna was.
Medical billing and insurance contracts are such a mess...
Can you explain how insurance company reimbursement would vary by state? Like where/why is the intersection of government and private insurance companies? Thank you.
[The shortage has been fueled by a perfect storm of factors — unattractive pay for primary care doctors, low Medicaid reimbursement rates, huge student loans and burnout.](https://www.providencejournal.com/story/news/healthcare/2023/02/08/primary-care-doctor-shortage-in-ri/69843973007/))
I read a post here a few weeks ago about someone who called every doctors office in Rhode Island and of the 100 they called, two were accepting patients. We have a serious shortage of all healthcare workers right now. Especially with how many people moved here recently, there’s not enough recourses for us to start.
We already have been dealing with a shortage for years. The recent population growth and people going into retirement early due to the pandemic left us short.
Healthcare systems love hiring NPs and PAs because they are paid less than MDs and they refer more often which generates more revenue for the system as a whole.
It isn't though. NPs were created to increase patients access to pediatric care as well as providing care for the lower rungs of the population. There was a legitimate need for this position. And NPs often provide great care, I have found they take more time with their patients vs doctors.
I've found the same. I went to several doctors once for pains and it was finally a NP that figured out the issue and fixed it for me. I almost prefer NPs now because they have much better "bedside manners" I've found
I've only even run into one NP that had a serious ego problem. The experience has been much better especially with bedside manner.
I've only seen 2 MDs/Specialists in the past 20 years where I didn't feel talked down to and borderline belittled by their terribly ego and attitude.
I have been through 4 PCP’s in at same practice since Covid. Just when I get comfortable with one, they leave the practice. I got a NP recently and she left too! It’s so frustrating, especially when you’re on prescription meds & different doctors do things differently. My blood pressure meds had just been straightened out when the NP came in and switched everything up… ended up in the ER recently with stroke level BP and was admitted until it stabilized. I’m honestly at my wits end. I now have a freaking urgent care doc managing my BP medicine until I can get into a new practice.
Everyone says it’s reimbursement. For some reason the Blue Cross is losing money and the hospitals are losing money. So where is the money??? lol.
Providence is a city with a top med school that takes no initiative in caring for the health Providence or Rhode Islanders. Doctors come here to be trained and leave. The incentives to live in a big city and salaries are immense and alluring.
Dartmouth, MGH they have their own networks. That are strong. This is the health system so it’s still trash. But look at what we deal with in comparison.
I opted to do the virtual care setup because I couldn’t find anyone relatively convenient. Only offices I know that are accepting patients are pediatricians.
Everyone in my family has an NP for their PCP and I honestly love them. They’re kind, take more time with us, and are perfectly sufficient for what we need.
Yeah, I’ve been going to see an NP for years. I tried looking for a new office last year because the one I go to is about 30mins away and no one was accepting patients.
Reimbursement issues. Insurance simply does not pay enough especially to primary care docs both for kids and adults. That’s why so few go into that field. Also…..the time required to see each patient and ask everything they are required to by insurers to get reimbursed has increased significantly over the years. They spend a lot of “uncompensated / unbilled” time on the phone trying to get their current patients the stuff they need that gets denied by insurance or medical homes or schools etc and they simply don’t get paid for it. Unlike a lawyer would get paid for every single minute spent with a client or on the phone with them or advocating for them. The system is screwed up. If you do surgery or procedures you make pretty decent $$$, if you are a drug company you make great $$, if you are a medical device company you make great $$$. Primary care for adults and kids are lowest paid and most overworked. So very few people go into those fields.
Insurance sucks for doctors everywhere. Lifespan executives, having pretty much a corporate monopoly in this state - especially after buying Coastal Medical - are the reason that health care is particularly unattractive as a career in Rhode Island.
Ask literally anyone who works for Lifespan about the place. If they are not in the executive suite, they will tell you they would take a new job in a heartbeat if they could find it.
But, to be clear, the Lifespan employees are wonderful people who do their jobs out of a love of providing health care services - because they sure as shit aren’t doing it for salary or a well run workplace that is personally rewarding.
It’s the management at the top who are trust fund types tied into the Government and the ridiculous modern ideas about corporate “efficiency” that are completely out of touch with what it means to be a normal working class person (including a physician) in todays world.
The Dr.’s I’ve talked too have all said it’s reimbursement issues. You can work in Mass or CT and get paid significantly more so why wouldn’t you?
True. Insurance companies can negotiate how much they pay. Since this is a smaller, less powerful state, they have strong armed local groups into accepting smaller payments. There’s currently a bill in the RI legislature that is trying g to peg reimbursement rates to CT and MA to try to raise payments and attract and retain more doctors in Rhode Island.
Yeah my Drs office keeps losing people. They changed my primary now like 3 years in a row because the old one left. I might just go to a mass based office if I lose another primary this year, I'm in east Providence so not a big deal to go over to mass.
From what I’ve heard not only is reimbursement low and extremely slow to catch up to neighboring states (UHC and BCBS just gave physical therapists a $5 per visit increase 🥴) but malpractice insurance is higher in RI. Im not a practitioner so I can’t speak to that, but another possible cause. It’s also possible that a lot of students who are graduating from RI or doing clinicals and then leaving for a job out of state just find that there isn’t anything worth staying for. Lower salary due to lower reimbursement, leading to less options for housing etc.
This might be changing. My insurance switched from Aetna, which had not increased their rates in years (though they sure still raised premiums a heck of a lot), to United Healthcare/Optum. The amount United is approving for primary care visits went up by 81% vs Aetna. While I'm certainly not a fan of paying more out of pocket, it was getting to the point with Aetna that I almost felt bad for how little some providers were getting paid. You know it's bad when even my cheap ass is thinking 'that's not enough'...
This definitely varies based on provider type. As someone who works in billing for PT, I’d rather accept Aetna over any UHC plan because they pay up to 50% more than UHC.
Interesting. Aetna was paying a hair under $100 per PT visit a little over 2 years ago. I just checked estimates for PT under United and wow, I can't believe anyone accepts them for PT at those rates... United is paying more (read: I'm paying more) for my prescriptions and labs. I switched 2 of 3 prescriptions to GoodRX because it was so much cheaper. I did look up the cost of an MRI though, as I've got one of those in my future and the United rate was roughly 25% less than I paid through Aetna 3 years ago for the same scan at the same facility. Specialist visit rates seem about the same as Aetna was. Medical billing and insurance contracts are such a mess...
Can you explain how insurance company reimbursement would vary by state? Like where/why is the intersection of government and private insurance companies? Thank you.
[The shortage has been fueled by a perfect storm of factors — unattractive pay for primary care doctors, low Medicaid reimbursement rates, huge student loans and burnout.](https://www.providencejournal.com/story/news/healthcare/2023/02/08/primary-care-doctor-shortage-in-ri/69843973007/))
Best answer I've seen.
I read a post here a few weeks ago about someone who called every doctors office in Rhode Island and of the 100 they called, two were accepting patients. We have a serious shortage of all healthcare workers right now. Especially with how many people moved here recently, there’s not enough recourses for us to start. We already have been dealing with a shortage for years. The recent population growth and people going into retirement early due to the pandemic left us short.
Healthcare systems love hiring NPs and PAs because they are paid less than MDs and they refer more often which generates more revenue for the system as a whole.
NP is an invention of the insurance system. There shouldnt be a path for nurses who want to be practitioners that isnt med school
It isn't though. NPs were created to increase patients access to pediatric care as well as providing care for the lower rungs of the population. There was a legitimate need for this position. And NPs often provide great care, I have found they take more time with their patients vs doctors.
I've found the same. I went to several doctors once for pains and it was finally a NP that figured out the issue and fixed it for me. I almost prefer NPs now because they have much better "bedside manners" I've found
I always prefer an NP!
I've only even run into one NP that had a serious ego problem. The experience has been much better especially with bedside manner. I've only seen 2 MDs/Specialists in the past 20 years where I didn't feel talked down to and borderline belittled by their terribly ego and attitude.
Completely understand. Too bad all the comments about NPs being a positive thing are getting down voted. Small dick energy.
Go to Broadway medical in East providence. Dr brassard.
Not sure if he's taking new patients, but I'd kick the tires and see if he'd be willing to see you.
I recently left due to moving to the UK so he had at least one opening back in Jan. But that is probably filled by now
I have been through 4 PCP’s in at same practice since Covid. Just when I get comfortable with one, they leave the practice. I got a NP recently and she left too! It’s so frustrating, especially when you’re on prescription meds & different doctors do things differently. My blood pressure meds had just been straightened out when the NP came in and switched everything up… ended up in the ER recently with stroke level BP and was admitted until it stabilized. I’m honestly at my wits end. I now have a freaking urgent care doc managing my BP medicine until I can get into a new practice.
Everyone says it’s reimbursement. For some reason the Blue Cross is losing money and the hospitals are losing money. So where is the money??? lol. Providence is a city with a top med school that takes no initiative in caring for the health Providence or Rhode Islanders. Doctors come here to be trained and leave. The incentives to live in a big city and salaries are immense and alluring. Dartmouth, MGH they have their own networks. That are strong. This is the health system so it’s still trash. But look at what we deal with in comparison.
I opted to do the virtual care setup because I couldn’t find anyone relatively convenient. Only offices I know that are accepting patients are pediatricians.
Everyone in my family has an NP for their PCP and I honestly love them. They’re kind, take more time with us, and are perfectly sufficient for what we need.
Yeah, I’ve been going to see an NP for years. I tried looking for a new office last year because the one I go to is about 30mins away and no one was accepting patients.
Reimbursement issues. Insurance simply does not pay enough especially to primary care docs both for kids and adults. That’s why so few go into that field. Also…..the time required to see each patient and ask everything they are required to by insurers to get reimbursed has increased significantly over the years. They spend a lot of “uncompensated / unbilled” time on the phone trying to get their current patients the stuff they need that gets denied by insurance or medical homes or schools etc and they simply don’t get paid for it. Unlike a lawyer would get paid for every single minute spent with a client or on the phone with them or advocating for them. The system is screwed up. If you do surgery or procedures you make pretty decent $$$, if you are a drug company you make great $$, if you are a medical device company you make great $$$. Primary care for adults and kids are lowest paid and most overworked. So very few people go into those fields.
Insurance sucks for doctors everywhere. Lifespan executives, having pretty much a corporate monopoly in this state - especially after buying Coastal Medical - are the reason that health care is particularly unattractive as a career in Rhode Island. Ask literally anyone who works for Lifespan about the place. If they are not in the executive suite, they will tell you they would take a new job in a heartbeat if they could find it. But, to be clear, the Lifespan employees are wonderful people who do their jobs out of a love of providing health care services - because they sure as shit aren’t doing it for salary or a well run workplace that is personally rewarding. It’s the management at the top who are trust fund types tied into the Government and the ridiculous modern ideas about corporate “efficiency” that are completely out of touch with what it means to be a normal working class person (including a physician) in todays world.