Twenty-Nine Percent of Patients Receiving Medical Care from 2016 to 2022 Did Not Visit a Primary Care Provider

March 16, 2023

Nationally, from 2016 to 2022, 29 percent of patients receiving medical care did not visit a primary care provider, according to a new white paper from FAIR Health. This ranged from a high of 43 percent in Tennessee to a low of 16 percent in Massachusetts. These and other findings are detailed in the new report entitled A Window into Primary Care: An Analysis of Private Healthcare Claims.

Drawing on the nation’s largest private healthcare claims database, US census data and National Plan and Provider Enumeration System (NPPES) data, this report provides an in-depth analysis of primary care with a focus on geography, physician versus nonphysician care and primary care specialties. In addition, the study reports on allowed amounts, telehealth utilization, diagnoses and behavioral health. Among the other key findings:

• Of the providers who performed primary care services in 2016-2022, 56 percent were physicians, while 44 percent were nonphysicians.
• The core-based statistical area (CBSA) with the lowest number of people per primary care provider in 2022 was Rochester, MN, with a ratio of 114.5, when measured by the provider’s primary practice location.¹ The CBSA with the highest number of people per primary care provider was Zapata, TX, with a ratio of 2,759.6, again when measured by the provider’s primary practice location. The ratio of population to primary care provider, however, differed if calculated based on the location where patients received care.²
• Nurse practitioners constituted the largest share of primary care providers by specialty (27 percent), followed by family medicine physicians (20 percent), internal medicine physicians (18 percent) and physician assistants (15 percent). Smaller percentages were accounted for by pediatricians, obstetricians/gynecologists and others.
• The five states with the highest percentage of primary care patients receiving care from a nurse practitioner in 2016-2022 were largely states that permitted full scope of practice. Conversely, the states with the lowest percentage were generally those that reduced or restricted practice.
• The five states with the highest percentage of primary care patients receiving care from a family medicine physician in 2016-2022 were more likely to be rural.
• From 2016 to 2022, average allowed amounts for CPT^®3 99395 (established patient periodic preventive medicine examination for patients 18 to 39 years old) increased more for physicians than for nonphysicians.
• Telehealth use sharply increased at the start of the COVID-19 pandemic in all primary care specialties studied. Telehealth use then declined by over 30 percent in all primary care specialties studied from 2020 to 2021.
• In the period 2016-2022, nonphysicians treated greater percentages of patients with diagnoses related to mental health or acute respiratory diseases and infections than physicians did.
• From 2016 to 2022, the percentage of patients with a primary mental health diagnosis treated by a primary care provider increased 7.0 percent, while the percentage of patients with a primary substance use diagnosis decreased 2.5 percent. Primary care nonphysicians saw increases in patients with both behavioral health diagnoses of over 100 percent during the same period.

FAIR Health President Robin Gelburd stated: “Primary care is vital to the nation’s healthcare system. We hope this study of primary care provides actionable findings for all healthcare stakeholders, including patients, providers, payors, policy makers and researchers.”

For the complete study, click here.

^{1 A CBSA is an area, designated by the Office of Management and Budget, containing a large population nucleus, or urban area, and adjacent communities possessing a high degree of integration with that nucleus.
2 Telehealth was not included in the analysis for location of services, so the location where patients received care included only in-person services.
3 CPT © 2022 American Medical Association (AMA). All rights reserved.}