It is pretty well-accepted that better primary care can keep patients in good health and potentially lower long-term spending. This supposedly occurs through delivery of more preventive care, early identification of potentially acute episodes and the role of a primary care doctor as a care coordinator. A new study looks at how much Medicare spends on primary care as a proportion of total spending. (JAMA Int. Med. Article) Depending on whether you define a primary care practitioner broadly or narrowly (the broader definition includes nurse practitioners and physician assistants, gynecologists and geriatricians in addition to family practice, pediatricians and internal medicine, so it seems obvious to me that the broad definition is more appropriate) and whether you define primary care services broadly or narrowly; primary care spending ranged from 2.12% to 4.88% of all spending. In annual dollars per beneficiary the range was $308.32 to $708.23. Arguably these amounts are not representative of true primary care spending, as they don’t include medications or tests ordered by primary care clinicians. Those items should properly be considered part of primary care. Spending as a percent tends to be higher for younger beneficiaries, probably because they don’t have as many serious conditions as older ones. There was also some variation among states. I suspect all of this analysis is highly correlated with actual health status. The authors don’t explicitly comment on whether they view the number as too low or too high, but the implication is that Medicare isn’t spending enough on primary care, given its supposed value. I am not sure either, but I think this kind of analysis really isn’t very helpful for policymakers. Many patients with one serious illness may use a specialist for that disease category as a primary care doctor. Some of the effect on spending is a unit price impact; primary care doctors tend to be much lower paid and reimbursed than are specialists. If you looked at primary care as a percent of utilization it would be a higher portion of all Medicare utilization than it is a percent of spending. And there has been some research trying to elucidate the actual impact of “better” primary care, and the results of that body of research are somewhat inconclusive. Getting patients in better health and achieving better health care outcomes is important, but I am not sure we know yet how much primary care has to do with that.
Medicare’s Primary Care Spending
By Kevin RocheApril 22, 2019Commentary
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
Another example of over-priced companies trying to find some way to survive in the post-epidemic financial world. Transcarent, which does something, somehow to “access high quality, affordable care” is buying...
March 6, 2023
In an attempt to swiftly revive two floundering health care companies, a PE firm has announced the merger and recapitalization of Revive Health and SwiftMD. You know they are...
January 30, 2023
Investors have not yet learned their lesson, as Pearl Health gathers a new round of $75 million in capital for its business of supporting physicians who want to participate in...
January 30, 2023
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace
March 31, 2023
Electric Vehicles Suck
Electric cars are more expensive to buy and operate than gas ones, and worse for…
March 31, 2023
Coronamonomania Lives Forever, Part 202
Such a depressing world and I am not sure these research summaries are particularly elevating.
March 31, 2023
And Then There is This…
Some supposed conservatives just spout conspiratorial nonsense that ensures that we lose, which is one…