Only a small fraction of total Medicare spending goes toward primary care, according to a RAND Corporation study published this week in the journal JAMA Internal Medicine. Depending on how narrowly “primary care” is defined, spending for such care accounts for either 2.12% or 4.88% of total spending under Medicare Parts A, B and D, the study finds. By comparison, primary-care spending averages 7.7% across commercial PPO plans, according to a 2017 study highlighted by Modern Healthcare.
"We knew that as you look at older and older age cohorts, that primary-care spending falls, but it's still a little galling to see a percentage that low," Dr. Mark Friedberg, a co-author of the study and director of RAND's Boston office, told Modern Healthcare.
The researchers say the estimates matters because “health system orientation toward primary care is associated with higher quality, better outcomes, and lower costs.”
The new study's narrow definition of primary care practitioners includes family practice, internal medicine, pediatrics and general practice. The broader definition includes nurse practitioners, physician assistants, geriatric medicine and gynecology. The study also looked at both narrow and broader definitions of primary care services, ranging from only office visits and preventive care to any service provided by a primary care provider.
The study found that primary care spending shares varied by state, and those variations were not tied to the number of primary care practitioners per capita in each state. Across the board, though, primary care spending levels were lower among Medicare beneficiaries who were older, black, native American or also eligible for Medicaid as well as for those with chronic medical conditions.