Family physicians, operating primarily in their offices, are responsible for a wide range of procedures, from simple surgeries to joint injections. However, the training they receive can vary significantly. To address this, the Council of Academic Family Medicine (CAFM) issued crucial recommendations on the essential procedures that family physicians should be proficient in upon completing their residency training. This study, therefore, holds significant weight as it assesses how often family physicians perform these CAFM-recommended procedures under Medicare Part B, which covers outpatient services. By examining these clinical activities, the researchers sought to gain profound insights into the role of family physicians in U.S. primary care.
Researchers analysed a publicly available dataset containing information on Medicare activities, including usage, payments, and charges. They matched Medicare patient encounter codes with CAFM-recommended procedures to determine the frequency with which family physicians reported performing these procedures in outpatient settings from 2014 to 2021. The methods were categorised according to the organ systems they targeted.
In 2021, a total of 9,410 family physicians submitted 904,278 claims for CAFM-recommended procedures, which covered 444,309 patients. However, the data reveals a concerning trend. Nearly all (99.92%) of these procedures fell into five main clusters: skin procedures accounted for 51%, musculoskeletal procedures for 36%, eyes, ears, nose, and throat (EENT) procedures for 9%, pulmonary procedures for 2%, and anesthesia procedures for 2%. Despite a slight increase (from 2% to 6%) in skin, musculoskeletal, and anesthesia procedures between 2018 and 2019, there was an overall 33% decrease in outpatient procedure claims and a 36% decrease in the number of family physicians filing these claims between 2014 and 2021. Only 12% of family physicians reported CAFM outpatient procedure claims in 2021, which represented less than 1% of all patient encounter codes submitted that year.
The findings highlight a concerning trend where fewer family physicians are billing for CAFM-recommended procedures over time despite an ageing U.S. population that typically requires more healthcare services. While procedures may increasingly be handled by physician assistants, nurse practitioners, or specialists following referrals, this decline among family physicians could reduce patient access to care and convenience while increasing healthcare costs. This trend underscores the importance of ensuring that primary care providers remain equipped and incentivised to perform essential procedures, thereby maintaining comprehensive patient care across different healthcare settings.
More information: Robert McKenna et al, Family Physicians as Proceduralists for Medicare Recipients, The Annals of Family Medicine. DOI: 10.1370/afm.3096
Journal information: The Annals of Family Medicine Provided by American Academy of Family Physicians
