As we have discussed here a time or two of late, one of the casualties of 2020 is the loss of the normal sense of time.
What day of the week is it? [One or two days past when your blog is due.]
How long have we been in this thing? [Don’t change the subject. Where is your blog post?]
Is it time for dinner? [No blog, no dinner.]
Fine, voice in my head, fine. I am writing now, I promise.
Today we diverge from all things 2020 and look at a longer-term issue.
A recent study published in the Annals of Internal Medicine examined 142 million primary care visits from a large national commercial payer. The data was from 2008-2016 and was for adults ages 18-64 years. No kiddos, no Medicare.
It found some big trends that are troubling for primary care providers.
Visits to PCPs declined by 24% over the period, from 170 per year per 100 members down to 134. In 2008, 38% of folks had no PCP visit in a given year. That rose to 46% in 2016.
The drivers were what you might imagine…lower acuity visits were way down (almost half); visits by young people were off 28%; visits by those without a chronic condition dropped 26%; visits in low income areas were down 31%.
Young, relatively healthy, relatively poor folks aren’t going to see their doctor as much. By a wide margin.
But maybe it was just the ‘their doctor’ part that is troubling because at the same time visits to alternative primary care venues like urgent care clinics increased by almost 50%.
In the ‘just in time’ world of the ubiquitous Amazon truck, in the ‘I want it fast’ world of 15 second TikTok videos, primary care seems to be viewed the same way by the next generation.
Throw in the news that at least one health plan is now including free, unlimited telehealth visits for their members and you see a big, long-term trend that does not bode well for primary care providers.
That the study found visits to specialists to be stable during the same time frame is noteworthy. It was not physicians in general that saw a net outflow, just primary care providers.
This all raises two slightly rude, slightly inappropriate questions from me…
This was the timeframe when tons of PCPs left private practice to become health system employed providers. Is that a factor in this trend at all? Just asking.
Also, this was the time of great reform, of accountable care, of the elevation of primary care on many fronts. So, after all this push, why does the consumer seem to be voting the opposite direction with their behavior? Again, just asking.
Now can I go get a snack?