IF SUBSTANTIVE LEGISLATION in Massachusetts takes about a decade to accomplish, Dr. Wayne Altman is hoping to pop the champagne three years early.
The professor and chair of family medicine at Tufts School of Medicine hopes that by summer 2026 lawmakers will enact “Primary Care for You” and make strides toward addressing the harsh primary care reality in the state.
“What we learned as we introduced these concepts [six years ago] is that legislation is the only way we could accomplish what we needed to accomplish,” Altman said on The Codcast. “Right now our health care system has so many problems: It’s incredibly expensive, it’s bankrupting families and businesses, and the access to primary care is terrible.”
The legislation proposed by Altman and his coalition targets 10 factors in the primary care crisis, from physician burnout to equitable access to affordability. It includes policy changes like doubling state investments in primary care, allowing practices to opt-in to make primary care free for patients, and replacing fee for service provider models with one lump sum per patient per month.
Massachusetts isn’t alone in grappling with high health care costs and a dwindling primary care workforce, but it is still trapped in a “vicious cycle” that needs serious policy reform to address, Altman told hosts John McDonough of the T.H. Chan School of Public Health and Paul Hattis of the Lown Institute.
A recent Health Policy Commission report released in January offered a “dire diagnosis” of the primary care landscape in Massachusetts. Primary care physicians in Massachusetts are barely increasing since the height of the pandemic, trailing the rest of the country.
This is in part, the report notes, because primary care is both a relatively low-reimbursed medical field – disincentivizing new clinicians and making practices difficult to sustain – and associated with high administrative burden, leading to decreased patient care hours and increased provider frustration and burnout.
The primary care workforce in Massachusetts is aging, Altman noted, with a third of primary care physicians over 60 years old and heading toward retirement. But others are also eyeing the exits.
“People are retiring early, people are shifting their practice to direct primary care, DPC, or concierge,” Altman said. “People are decreasing their hours, and when you decrease your hours, you have less capacity to care for patients. When you shift to a concierge practice, you go from having 2,000 patients to 500 patients. And every time somebody leaves or reduces their hours or reduces their patient panel size, it leaves the same amount of work or more work for the rest of us.”
Three “complementary” but “incomplete” bills – filed by Sen. Cindy Friedman, Rep. Greg Schwartz, and Rep. Rich Haggerty – offer some possible solutions to the crisis and all resemble legislation filed last session called “Primary Care for You,” Altman said. They all build on the prior bill’s promises, respectively including supports for community health centers and mental health care, supports for Medicaid payments for graduate medical education and increased training of future primary care physicians, and a primary care stabilization fund.
The primary care stabilization fund would collect money from the commercial payers such as Blue Cross Blue Shield of Massachusetts and deliver those funds directly to primary care practices, Altman said, dramatically reducing the administrative burden of primary care practice.
Paying for primary care is a lift, Altman acknowledges, but it reduces unnecessary emergency room visits and hospitalizations. “At 49 months, at about four years into this legislation,” he said, “this legislation will pay for itself.”
For more with Dr. Wayne Altman – on who is expected to fork over the money to stabilize primary care, the special primary care commission, and unionizing primary care physicians – listen to The Codcast on Apple Podcasts, Spotify, or wherever you listen to podcasts.
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