Patients' access to care hasn't been hurt by a decline in the number of practicing primary-care physicians, but a continued drop-off in the rate of new physicians could create problems down the line, according to new research presented Thursday.
The Medicare Payment Advisory Commission found that about 1 in 5 physicians that it previously considered primary-care physicians are actually hospitalists—physicians whose focus is providing medical care to hospitalized patients. It now estimates that the number of primary-care physicians was closer to 140,000 in 2017 than the 186,000 it initially reported, a decrease of about 46,000.
The lower numbers haven't decreased access for Medicare recipients, which is as good or better than access for privately insured people, MedPAC said. The commission noted that Medicare beneficiaries are less likely to wait for routine care than people with private insurance.
But MedPAC is concerned by a steep decline in the growth rate of new primary-care physicians, which fell from 0.7% to -0.6% in 2017 after the agency excluded hospitalists. It's worried that Medicare beneficiaries might have a harder time gaining access to primary care if the relative number of primary-care physicians goes down long term.
The commission previously asked its staff to look into whether it should change how it evaluates Medicare payment rates for providers under the physician fee schedule. The agency currently decides whether its payment recommendations are adequate based on beneficiaries' access to care, quality, Medicare payments and provider costs.
MedPAC couldn't distinguish hospitalists from primary-care physicians before 2017, but a new specialty designation for hospitalists made it possible to split them out. The early findings suggest that excluding hospitalists from the number of primary-care physicians might improve the commission's ability to figure out if reimbursements for primary care are appropriate.
Some MedPAC members were hesitant to carve hospitalists out of the primary-care physician measure because most of them provide some level of primary-care services, especially for patients with severe illnesses. They also wondered whether an increase in advanced practice nurses and physician assistants might support primary-care access, even as the number of primary-care physicians relative to Medicare recipients drops off.
MedPAC's staff will present ongoing work about the primary-care physician pipeline at next month's meeting.