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Public Policy & Advocacy

On April 10, 2007, our new Governor sent the following letter to Blue Cross/Blue Shield of Rhode Island advocating for us to receive an increase in the fee schedule.


James E. Purcell
President and CEO
Blue Cross/Blue Shield of Rhode Island
444 Westminster St.
Providence, Rhode Island 02903-3279

Dear Jim:

I would like to commend your efforts to promote primary care in Rhode Island. I think it is clear that the primary care physician community is the bedrock of an efficient and high quality health care system. Internists, as well as family physicians and pediatricians provide preventive care, diagnose and treat various medical problems, coordinate care in the health care system, provide hospital care, manage chronic medical problems and counsel end of life decisions.

As you know, these services have over time become under valued in terms of respect within the medical profession and reimbursement from payers. The payment structure has led to a relative shortage of primary care locally and nationally. This shortage will become more critical as our population ages through the first third of this century. Medical students and residents with significant financial obligations choose higher paying specialties. Further, it will be difficult to retain and recruit primary care physicians in Rhode Island as our provider population also ages.

The American College of Physicians (ACP) is the largest specialty organization in the United States with 125000 members and 600 members in Rhode Island. The College represents internists, related sub specialists, medical residents and students. The College strongly advocates for a patient centered, longitudinal and coordinated care delivery system. The College believes that Health Information Technology (HIT) can improve the quality of care and result in healthcare savings.

I was pleased to see the recognition by Blue Cross of the prohibitive nature of an investment in HIT by primary care providers under the current reimbursement structure. The support through an increase in the fee schedule will mitigate some of these issues.

The Rhode Island Chapter of the ACP appreciates the increase in fees, but would like your consideration of the following issues:

  • The reimbursement for primary care should reflect the importance of the issues outlined in this letter, such as coordination of care; chronic care management, challenges of diagnosis and treatment of complex medical problems and preventive medicine.
  • The above reimbursement level should be independent of the adoption of HIT, though the Chapter supports this initiative to increase adoption rates and subsequent quality and efficiency of care.
  • Regional parity is essential to retention of established primary care physicians. The Chapter would recommend further rate increases be consistent with reimbursement in neighboring states after the three-year "catch up" period.
  • A change in the model of reimbursement to reflect the change in the delivery of care through the Advanced Medical Home.
  • Extension of the payment increases to the Medicare Blue Chip and Rite Care population.
  • Support the state effort to build a health information exchange.

The Chapter members are appreciative of your efforts and are excited about working with Blue Cross on a collegial and professional basis to improve health care for all the citizens of Rhode Island.

Thank you again and please contact me for further discussion or questions.

Sincerely yours,

Nitin S. Damle MD FACP
Governor-Elect, Rhode Island Chapter, ACP

Page updated: 4/26/07