The crisis in primary care: What does the future hold?
By Zoë Buhrmaster/Montana Fellow
Despite the data backing primary care as an effective way to fight chronic disease and lower health care costs, the field is under-resourced and overburdened, physicians said during an HJ26 session. Panelists pointed to the nation’s fee-for-service (FFS) system as a leading factor and shared possible solutions to growing the field, including relying upon often overlooked nurse practitioners.
An analysis of Medical Expenditure Panel Survey data from 2016 to 2022 shows that adults who regularly see a primary care physician are 20% less likely to have a hospitalization and 11% less likely to have an emergency department visit. For children, the impact is even higher, said Yalda Jabbarpour, M.D. Data from the same analyses shows kids are 50% less likely to have ambulatory care sensitive conditions and hospitalizations.
“Primary care is the backbone of the health care system, but the data that we found in the Medical Expenditure Panel Survey shows that only 5% of total health care expenditures actually goes to primary care,” Jabbarpour said.
She pointed to the FFS system, a transactional model for health care payments in the United States that reimburses physicians based on value unit codes. For primary care, which relies upon a continuity of care and developing a relationship with patients to better understand their specific needs, the FFS model fails to reimburse physicians for time that is not identifiable with a code.
Overburdened physicians are subsequently often leaving the workforce, said Kate Schreck, M.D., noting that many doctors are moving to smaller direct care practices or working part time.
In Minneapolis, Schreck is working on building recruitment by exposing medical students to positive primary care experiences before they graduate. Well-resourced teams can look for alternative funding resources, she said. Practices can allow providers to create their own schedule to help reduce burnout, she added.
“Autonomy is a big one when we think about retention in the workforce,” Schreck said.
Both doctors said the payment model is in need of reform particularly for primary care reimbursement methods nationwide, something CMS has only recently begun to look into.
Jessica Horstmann, a nurse practitioner at a federally qualified health center, added that nurse practitioners are already boosting primary care access and are projected to continue the trend. Practitioners are one of the fastest growing professions in the United States and now make up 47% of all primary care clinicians, according to a study by the Milbank Memorial Fund.
“You’ll often hear that what nurse practitioners bring is filling gaps in care and filling gaps in the physician workforce,” Horstmann said. “I want to push back on that language. Nurse practitioners provide a complementary role that’s valuable in its own right and it intentionally operates under a different model. We’re not gap fillers, we are expanding access to care.”
Zoë Buhrmaster is a staff writer for the Flathead Beacon.
