It's Time to Properly Compensate Primary Care Physicians

Primary care is the foundation of our healthcare system, yet primary care physicians, particularly pediatricians, are consistently underpaid compared to specialists. This needs to change. The Primary Care Collaborative put out a white paper that all pediatricians and leaders in physician organizations should read. ¹

Primary care physicians (PCPs) provide comprehensive, continuous, and coordinated care for patients. They are often the first point of contact for individuals seeking medical attention and play a crucial role in disease prevention, chronic disease management, and coordinating care with specialists. Yet, as PCC and others point out in the graph below, we invest less in primary care than we do in administrative fees.

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The current payment model heavily favors specialty care over primary care. PCPs are paid at much lower rates than specialists for the same services. This has led to a growing shortage of primary care providers, as many new medical graduates opt to pursue more lucrative specialty careers. As the chart below shows, this causes a lack of access to care, particularly to the population that the big organization wants to elevate, like the underresourced non-white children and pregnant mothers, because of the marginal payment by most Medicaid Plans in the USA.

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The COVID-19 pandemic has further exacerbated the strain on primary care. PCPs have been on the frontlines, managing the surge of patients while also dealing with financial pressures from decreased patient volumes. Many primary care practices have been forced to close or severely cut back services.

It's clear that we need to fundamentally rethink how we value, invest, and compensate primary care in this country. Providing adequate and equitable payment for primary care services is essential to:

- Attract and retain more medical graduates into primary care specialties

- Ensure patients have access to high-quality, comprehensive primary care

- Reduce healthcare costs by emphasizing preventive care and chronic disease management

Policymakers and payers must act now to close the payment gap between primary care and specialty care. Increasing payment rates and investing in primary care infrastructure are all critical steps.

A step forward today is to pay for screening tools, care coordination, and longitudinal care at 200% of Medicare, as AMA CPT and the US Congress have agreed to. This would be a di minimus cost to the system ( even a 50% pay increase would be 2 % of overall spending ) that could immediately improve access to care for all.

1. G2211 Visit complexity is inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's single, serious condition or a complex condition.

2. 99487 complex CCM is a 60-minute timed service provided by clinical staff to substantially revise or establish a comprehensive care plan that involves moderate- to high-complexity medical decision-making.

3. 96127, Brief emotional/behavioral assessment (e.g., depression inventory, attention-deficit/hyperactivity disorder scale), with scoring and documentation, per standardized instrument.

The health of our communities depends on a strong, well-supported primary care foundation. It's time to properly compensate the healthcare heroes who are the backbone of our medical system.

What do you think needs to be done to address the primary care payment crisis? I'd love to hear your thoughts in the comments.

1. https://thepcc.org/sites/default/files/resources/Hiding%20In%20Plain%20Sight%20-%20Investing%20in%20Primary%20Care%206.2024_0.pdf

2. “Fact Sheets National Health Expenditures 2022 Highlights,” Centers for Medicare & Medicaid Services, December 13, 2022, https://thepcc.pub/2022-Expenditures-CMS.

3. Yalda Jabbapour, et al., “The Health of US Primary Care: 2024 Scorecard Report - No One Can See You Now,” Milbank Memorial Fund, February 28, 2024, https://thepcc.pub/2024-MMFPC-Scorecard.