New York's Primary Care Reimbursement System: A Roadmap to Better Outcomes

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This report by the Primary Care Development Corporation in conjunction with RSM McGladrey, Inc. analyzes NewYork’s current reimbursement for the primary care sector, particularly for providers who deliver primary and preventive care in underserved communities, and offers principles and recommendations for reforming the reimbursement system. A thorough understanding of the financial systems is not only crucial to understanding the current primary care system—its shape, size, services, delivery mode, and shortfalls—but to developing a strategy for transforming it into a system capable of producing positive health outcomes while reducing unnecessary costs.

Ambulatory care includes patient services provided on an outpatient basis. This report focuses on a subset of ambulatory care, namely primary care. Primary care to the underserved in New York City (NYC) and New York State (NYS) is provided by three fundamental groups of providers: 1) hospitals in their outpatient departments and community-based satellite centers, 2) freestanding health centers (technically called diagnostic and treatment centers or D&TCs), and 3) private physician practices. Each is organized and reimbursed differently for services provided to the healthcare safety netpopulation and, as a result, each sees a different mix of patients and offers a different model of care.