COMMENTARY

Yes, Nurse Practitioners Are Primary Care Providers

Peter McMenamin, PhD

Disclosures

February 25, 2014

In This Article

Idealized Primary Care

In Dr. Bazemore's interview on Medscape, he used a vintage description of primary care: "Definitions of primary care...presume that primary care includes first contact, coordinated, comprehensive, and continuous care. The 2008 World Health Assembly[2] on the topic also described primary care as a place to which people can bring a wide range of health problems, a hub from which patients are guided through the health system, and an opportunity for disease prevention and health promotion as well as early detection of disease." Dr. Bazemore also suggested that this type of primary care is thought to account for only 6% of total US health care spending.

Dr. Bazemore alluded to this somewhat rigid definition of primary care involving a broad set of services delivered with strong continuity over time and encompassing everything from greeting the patient at the office door to the final encounter, by which time the originating set of clinical problems has been completely addressed. One might be tempted to call it "Welby-care" rather than primary care, and perhaps it might be measured in relative "Marcus units." There are no current procedural terminology (CPT) codes for Welby-care and no concrete estimates of how often it occurs. The estimate of 6% of total healthcare spending might be biased upward with respect to primary care as defined. As it happens, this Welby-care definition of primary care was not the definition used in the analysis of NP primary care practice conducted by the Graham Center.

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