When specialists provide primary care, and why patients aren't complaining

A study recent came out showing that specialists are providing a greater proportion of primary care services to patients.

According to the Annals of Family Medicine, “Researchers looked at more than 1 billion ambulatory visits to U.S. office-based specialists in 2002-04 and found that 46.3% of visits were for routine follow-up and preventive care of patients already known to the specialist, while referrals accounted for only 30.4% of all visits.”

That’s an important finding, since care at a specialist venue is coded at a higher rate, and thus, can increase health care costs.

I suspect, from a patient’s standpoint, having a specialist provide primary care can save a co-pay from another office visit. And in a recession, saving co-pays matter.

But, specialists shouldn’t be providing primary care in the first place, and by shielding patients from the true cost of care, that’s exactly what’s happening.

Comments

The Happy Hospitalist
The game is volume. Do more make more. I wonder how many of those visits would be necessary if the doctor received a bundled yearly fee for taking care of the patient.
Take it or leave it.
As opposed to come back every three months until the end of time.
Anonymous
That’s why increasing reimbursement for cognition is not a panacea. Specialities do cognitive work as well and can compete directly for those patients. With any type of marketing most patients will choose the specialty. A medicare patient that has a sprained ankle is offered the choice of her familiy doctor vs an orthopedic surgeon at two competing clinics, it’s going to be an easy decision.
Anonymous
A number of my primary care patients have complicated problems with fairly toxic medications or medication combinations, I would not call follow up of those issues primary care.
There’s also financial pressure on primary care physicians to let specialists handle follow up, especially on low paying but complicated Medicare patients. When 25 grandmas come in expecting to get their laundry list of complicated chronic issues addressed at each 15 min. visit, most of us are happy to let the specialists take a few problems off the list. I’d rather spend more time and handle things at the primary care level but we can’t do that at what Medicare pays and patients are resistant to coming in more frequently.
thecountrydocreport
I’d interpret this study as further evidence that our society still equates specialists with superior care despite many studies that show for many conditions better outcomes are achieved at lower cost with primary care.
One family physician colleague prefers be called a generalist and refers to specialists as partialists in his attempt to take some shine off of this apple.
Anonymous
what does ‘care provided at a specialist venue is coded at a higher rate’ mean?
Anonymous
do specialist actually get paid more or do they do more procedures that get reimbursed better?
I have spoken to one of my friends who’s a family physician and we get paid exactly the same for the same code?
Anonymous
Family practitioners have only themselves to blame. The marketing of their work is exceedingly poor. How would the public know, unless they read physician blogs, what the benefit of a family physician is, how they can save you money, etc?
Right now, to the public a doctor is a doctor is a doctor. Where the treatment comes from doesn’t matter .
Anonymous
I just got a bill from my PCP. Of course I didn’t see my doctor, I saw one of the PAs because my doc was too busy-$290. That’s more than I spent on my first visit to a specialist I work with for a complicated medical condition. I regret not having got to him instead. At least I would have seen a doctor.
Michael Rack, MD
agree with anon 8:51
As a (sleep)specialist, I am paid at the same rate for office visits as a PCP.
Anonymous
I get paid the same as any generalist in my community for the same office CPT codes. And procedures come with mandatory post-procedural followup, usually 90 days, where none of the visits are paid.
What the complaining generalists envy is pay for procedures, not the hours of postoperative care involved, or the preoperative evaluation or the additional years required to master those procedures, or the added costs of materials and supplies to be able to do those procedures or the extra malpractice insurance costs involved.
And how many family doctors do OB or colposcopy or colonoscopy? All that is within the range of available practice options, if you want to bill for procedures. What I am hearing is whining about not getting procedural pay for non-procedural work. Here’s news, specialists in so-called “procedural” specialties don’t get that either. In fact, many office visits associated with those supposedly lucrative procedures are bundled with the procedural fee and get paid nothing.

When specialists provide primary care, and why patients aren’t complaining

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