Picture an elderly woman in Camden — a widow in her late 70s managing diabetes, heart failure and the early stages of dementia.
Her primary care visits are rarely simple. Her physician reviews medications, coordinates with specialists, asks about a recent fall and talks with her daughter about what is happening at home. This is the kind of careful, coordinated care that can help prevent an avoidable trip to the emergency department.
Her physician is working inside two different payment systems that can pull in opposite directions. One determines what a practice is paid for seeing Medicaid patients. The other determines how many health care organizations reward physicians for their work.
In New Jersey, both can make time-intensive primary care harder to sustain.
A 2024 analysis by Kaiser Family Foundation, a national nonprofit health policy organization, found that New Jersey’s fee-for-service Medicaid primary care fees averaged about 48% of Medicare fees, compared with 66% nationally.
That gap is not an accounting detail. It matters most in practices that care for large numbers of Medicaid patients.
New Jersey’s federally funded health centers served 643,753 patients in 2025, and about half were covered by Medicaid or CHIP. When payment is low, there is less room to support the clinicians, staff and care coordination that medically complex patients often need.
Paid for volume, not time
Separate from reimbursement is the way many physicians are compensated inside health systems and medical groups.
A common measure is the work relative value unit, or wRVU, which assigns a value to the clinician work associated with a billed service. SullivanCotter’s 2026 physician compensation survey found that base salary and wRVU productivity remain among the most prevalent components of physician compensation plans, while individual productivity is used by 73% of responding organizations in incentive compensation.
RVUs do account for time and complexity. But productivity-heavy models can still make long, coordination-intensive primary care less attractive than work that generates more billable activity.
Reviewing records, communicating with specialists, answering family questions and managing chronic illness between visits are essential to good care, yet they are not always rewarded in proportion to the time they require.
Medicare itself has begun recognizing this problem by paying an additional amount for certain office visits involving ongoing, complex or longitudinal care through the G2211 visit complexity add-on.
Why the safety net feels it
For New Jersey’s safety net, the stakes are practical.
The state’s 2025 Health Care Access and Regional Trends (HART) report tracks primary care workforce adequacy and health professional shortage areas across counties.
Payment is not the only factor behind workforce shortages — geography, workload, training pipelines and local labor markets matter too — but reimbursement affects what practices can invest in clinicians, support staff and the infrastructure needed to keep patients connected to care.
For physicians, that pressure can translate into shorter visits, crowded schedules and more work spilling into evenings and weekends. It also creates a difficult professional tension: Clinicians know that complex patients need time, yet the economics of practice may reward throughput more than thoughtful, coordinated care.
Over time, working within schedules and payment structures that do not fully recognize that complexity can contribute to burnout and moral distress.
What Trenton can do
One proposal before the Legislature is Senate Bill 3802, with Assembly counterpart A4265. As introduced, the bills would require Medicaid reimbursement for specified primary care and mental health services to be no less than Medicare Part B rates. A4265 has been referred to the Assembly Aging and Human Services Committee.
The proposal is one way to address New Jersey’s payment gap, but rate levels are only part of the larger question.
Payment design matters too.
Maryland, for example, is participating in the federal AHEAD model, which includes prospective, risk-adjusted primary care payments designed to support care coordination and whole-person care.
Other states are also experimenting with value-based primary care payment. These approaches are not a template New Jersey must copy, but they show that primary care can be financed in ways that recognize complexity, continuity and population needs rather than relying mainly on visit volume.
The elderly woman in Camden does not need more billing complexity. She needs a physician who has enough time to manage her care before a preventable crisis sends her to the hospital. New Jersey’s challenge is to make sure its payment systems support that kind of care — especially for patients whose medical and social needs are greatest.
The real test of reform is not whether a new formula looks better on paper. It is whether patients can find a primary care clinician, get an appointment and receive the time and coordination their health requires.
Moishe B. Singer is a health care executive based in New Jersey and a doctoral candidate at the Edward J. Bloustein School of Planning and Public Policy at Rutgers University, where his research focuses on physician burnout in ambulatory care settings.
Soumitra S. Bhuyan is executive director of the Health Administration Programs at the Edward J. Bloustein School of Planning and Public Policy, Rutgers-New Brunswick.
