Primary care is crucial to U.S. health care, but declining. The Commonwealth Fund offers suggestions on how to invest more in it.
The future of primary care is at risk and The Commonwealth Fund has proposed options Congress could consider to strengthen primary care through Medicare payment reform.
Amongst a few recommendations, Commonweath is encouraging how and how much we as payers, providers and consumers pay for primary care.
Primary care, critical for improving health and addressing patient needs, is on a decline for many reported reasons. According to a Commonweath report, the percent of people reporting a usual source of care is falling. This could be due to increased lack of patient access, the increase in physician burnout, fewer physicians choosing to go into primary care and physicians retiring in rural areas.
In relation to the investment aspect of primary care, there are two factors contributing to the fall of primary care as reported in 2021 by the National Academies of Sciences, Engineering, and Medicine (NASEM). These two factors result in decades of underinvestment and issues related to how we pay for care.
The portion of healthcare dollars going to primary care is small and decreasing over time across payers. According to Commwealth, the U.S. spends an estimated 4% to 6% of total healthcare dollars on primary care. For Medicare, primary care represents roughly 3% of spending.
Low reimbursement for primary care services play into what accounts for the underinvestment in primary care. In addition, reliance on fee-for-service payment leaves clinicians maximizing volume and rushing visits.
Medicare can have a profound impact in addressing these issues and revitalizing primary care in the U.S., according to Commonwealth.
"Primary care payment reform in Medicare can help restore balance to a health care financing system that is badly misaligned," a passage in the report said. "As a long-term investment, restructuring primary care can address the workforce shortage, improve the health of the population, and create greater equity."
Based on ideas generated by NASEM and the Medicare Payment Advisory Commission (MedPAC), below are options encouraged by Commonwealth that Congress could consider to strengthen primary care through Medicare payment reform: