A window into primary care: an analysis of private healthcare claims
- Collection:
- Health Policy and Services Research
- Series Title(s):
- White paper (FAIR Health, Inc.)
- Contributor(s):
- FAIR Health, Inc., issuing body.
- Publication:
- New York, NY : FAIR Health, Inc., March 15, 2023
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Nurse Practitioners -- statistics & numerical data Physicians, Primary Care -- statistics & numerical data Primary Health Care -- statistics & numerical data United States
- Genre(s):
- Technical Report
- Abstract:
- Primary care is at the heart of the healthcare system. Since the early 2000s, however, the nation has been experiencing a primary care shortage, with declining access affecting many Americans. To shed more light on primary care, FAIR Health delved into its database of private healthcare claims--the largest in the nation--as well as other data sources such as US census data and National Plan and Provider Enumeration System (NPPES) data, to provide an analysis of primary care with a focus on geography, physician versus nonphysician care and primary care specialties. The study also examines allowed amounts, telehealth utilization, diagnoses and behavioral health. Among the key findings: (1) Nationally, 29 percent of patients who received medical services between 2016 and 2022 did not visit a primary care provider. This ranged from a high of 43 percent in Tennessee to a low of 16 percent in Massachusetts. (2) Of the providers who performed primary care services in 2016-2022, 56 percent were physicians, while 44 percent were nonphysicians. (3) The core-based statistical area (CBSA) with the lowest number of people per primary care provider in 2022 was Rochester, MN, with a ratio of 114.5, when measured by the provider’s primary practice location. The CBSA with the highest number of people per primary care provider was Zapata, TX, with a ratio of 2,759.6, again when measured by the provider’s primary practice location. The ratio of population to primary care provider, however, differed if calculated based on the location where patients received care. (4) Nurse practitioners constituted the largest share of primary care providers by specialty (27 percent), followed by family medicine physicians (20 percent), internal medicine physicians (18 percent) and physician assistants (15 percent). Smaller percentages were accounted for by pediatricians, obstetricians/gynecologists and others. (5) The five states with the highest percentage of primary care patients receiving care from a nurse practitioner in 2016-2022 were largely states that permitted full scope of practice. Conversely, the states with the lowest percentage were generally those that reduced or restricted practice. (6) The five states with the highest percentage of primary care patients receiving care from a family medicine physician in 2016-2022 were more likely to be rural. (7) From 2016 to 2022, average allowed amounts for CPT3 99395 (established patient periodic preventive medicine examination for patients 18 to 39 years old) increased more for physicians than for nonphysicians. (8) Telehealth use sharply increased at the start of the COVID-19 pandemic in all primary care specialties studied. Telehealth use then declined by over 30 percent in all primary care specialties studied from 2020 to 2021. (9) In the period 2016-2022, nonphysicians treated greater percentages of patients with diagnoses related to mental health or acute respiratory diseases and infections than physicians did. (10) From 2016 to 2022, the percentage of patients with a primary mental health diagnosis treated by a primary care provider increased 7.0 percent, while the percentage of patients with a primary substance use diagnosis decreased 2.5 percent. Primary care nonphysicians saw increases in patients with both behavioral health diagnoses of over 100 percent during the same period.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (39 pages))
- Illustrations:
- Illustrations
- NLM Unique ID:
- 9918610383606676 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/9918610383606676