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Research Letter
April 15, 2019

Primary Care Spending in the Fee-for-Service Medicare Population

Author Affiliations
  • 1RAND Corporation, Boston, Massachusetts
  • 2Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
  • 3Harvard Medical School, Boston, Massachusetts
  • 4RAND Corporation, Santa Monica, California
JAMA Intern Med. 2019;179(7):977-980. doi:10.1001/jamainternmed.2018.8747

Greater health system orientation toward primary care is associated with higher quality, better outcomes, and lower costs.1,2 Recent payment and delivery system reforms emphasize investment in primary care,3 but resources presently devoted to primary care have not been estimated nationally.4,5 In this study, we calculated primary care spending as a proportion of total spending among Medicare fee-for-service beneficiaries and describe variation by beneficiary characteristics and by state.

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    2 Comments for this article
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    We get what we pay for
    Brian Crownover, MD | Independent Clinic
    For primary care to deliver the majority of visits in the US (https://www.cdc.gov/nchs/fastats/physician-visits.htm) and receive less than 1/4 of the Medicare spend on physician services (appx 20% of Medicare spend is on physician services), it is no surprise the USA continues to rank last in the developed world (https://medium.com/@harsh.singh.clif/u-s-health-care-ranked-worst-in-the-developed-world-1d397cd291c6).

    Primary care is a great investment that high-performing health systems consistently support. Research shows that greater use of primary care is associated with lower costs, higher patient satisfaction, fewer hospitalizations and emergency department visits, and lower mortality. (https://www.milbank.org/2017/07/getting-primary-care-oriented-measuring-primary-care-spending/)
    CONFLICT OF INTEREST: None Reported
    Primary Care and Medicare
    Paul Nelson, M.D., M.S. | Family Health Care, P.C. retired
    Since Medicare does not have a means to reliably indicate a person's primary physician at the time of any reimbursable healthcare encounter, it would be largely futile to assess the portion of Medicare health spending that originated from the professional involvement of primary healthcare. The CMS efforts to refine it for MIPS is a good example of its futility.

    The efforts in Rhode Island to improve the reimbursement of primary healthcare could eventually "tell the tale." The state legislature enacted a mandatory requirement to increase the reimbursement by private health insurance payors. The mandated increase
    occurred at 1% a year for 2010-2014 without an increase in premiums. The original plan involved a variety of complex regulatory requirements for health insurance. Recently, a report on the Rhode Island experience appeared in Health Affairs (February 2019). I suspect that "more to come" applies.
    CONFLICT OF INTEREST: None Reported
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