How can Rhode Island fix its primary care crisis? Here are some proposed solutions.

A nearly year-long state-led review says Rhode Island's primary care provider shortage will only worsen without major changes to insurance payments, administrative burdens and more.

The report, released Tuesday, comes from the Office of the Health Insurance Commissioner, or OHIC, which was established in 2004 to examine health insurance policy reform and act as a regulatory enforcement agency for commercial insurers.

Through interviews with physicians, insurers and other stakeholders, OHIC illustrated a dire situation rife with burnout, educational debt, and insufficient insurance reimbursements. Many providers are looking at retiring, while newly-minted doctors fresh out of school aren't rushing to find work at Rhode Island practices.

But OHIC says it has some solutions.

'How did this happen?': Primary care shortage keeps hitting RI hard

Here's what the state says could help solve the crisis:

The report proposes several solutions to the crisis. Here are a few big ones:

  • Higher insurance payments for primary care: That means larger reimbursements for the work primary care doctors do, like evaluating patients and managing their conditions. Right now, Medicare reimbursement in Rhode Island is nearly 4% lower than Connecticut and nearly 8% lower than metropolitan Boston.

  • Better pay for primary care physicians: OHIC wants a guarantee from places like Lifespan and Care New England that higher insurance reimbursements will translate to more pay directly to doctors providing care.

  • Cutting back on administrative hassles: OHIC actually has an Administrative Simplification Task Force specifically for figuring out how to do this. Prior authorization – the process through which doctor's offices get approval from insurers to go ahead with a procedure so it can be covered by insurance – is a big slice of the administrative burdens practices face.

"I think providers want to deliver care," Acting Health Insurance Commissioner Cory King said. "They don’t want to fight with insurance companies on the phone about the care they want to provide or that they think is appropriate."

OHIC says its task force is working on recommendations to scale back such burdens.

"What we want to try to do is look at prior authorization lists … understand what percentage of the time they’re approved," King added. "Some of these have really high approval rates, and it leads you to ask why are these on the list if they’re approved 95% of the time?"

  • Incentives for graduates to stay local: This could mean loan forgiveness for primary care providers, among other solutions. According to the Education Data Initiative, a research hub, the average medical school graduate carries about $250,995 in total student loan debt. Minimum monthly payments can average $2,275, the organization says.

More: Finding a primary care doctor in Rhode Island is getting more difficult. Here's why

Primary care physicians making less than half of some specialists

Consider that debt, then consider how easy (or hard) it might be to pay it off depending on where a graduate decides to work. If it's orthopedic surgery, a top-paying specialty, they can expect to make a $565,000 salary. Cardiologists and urologists aren't far behind. Internists and family medicine physicians, however, make just over $250,000 per year.

"If you’re in medical school and you’re likely to leave with $200,000 in debt … you have to think about economics and what are my lifetime earnings going to be," King said.

Those graduates are possibly weighing whether they can buy homes and start families.

"It’s those numbers," King said, "that medical school students are having to run in their heads."

This article originally appeared on The Providence Journal: Here's how Rhode Island may be able to ease its primary care shortage