Office Visits to Primary Care Physicians Down Sharply

Megan Brooks

November 15, 2018

Fewer adults are seeing their primary care physician (PCP), opting more often to see a nurse practitioner (NP) and physician assistant (PA), according to a new research brief from the Health Care Cost Institute (HCCI), a nonpartisan, nonprofit organization launched in 2011.  

"The decline in primary care visits comes at a time when awareness has grown of the role of primary care in prevention and in containing overall medical spending," Niall Brennan, president and chief executive officer of HCCI, said in a statement.

To analyze trends in PCP utilization, HCCI analysts evaluated all claims from 2012 to 2016 for adults younger than age 65 years with employer-sponsored health insurance (ESI) offered by Aetna, Humana, Kaiser Permanente, and UnitedHealthcare. 

Overall, they noted a 2% decrease in all PCP office visits from 2012 to 2016.

In 2012, 51% of office visits were to PCPs; in 2016, the PCP share of total office visits had fallen to 43%, the report notes. Office visits to PCPs declined 18% between 2012 and 2016, from 1510 visits per 1000 members in 2012 to 1237 in 2016.

At the same time, office visits to NPs and PAs jumped by 129%, from 88 visits per 1000 people in 2012 to 201 in 2016. The rate of office visits to specialists and other nonphysician providers remained relatively unchanged over the period.

Every state experienced a decrease in PCP office visits between 2012 and 2016, ranging from a 6% decline in Washington, DC, to a 31% decline in North Dakota. Every state also saw an increase in NP/PA office visits, ranging from 37% in New Mexico to 285% in Massachusetts.

The report also notes that while visits to NPs and PAs may have substituted for some of the visits to PCPs, the total increase in NP/PA visits accounts for just 42% of the total decline in PCP visits during the study period.

"The number of NPs and PAs in the United States has been expanding as has their role in providing primary care. Having more NPs and PAs provide primary care may ease the potential shortages in PCPs and allow PCPs to focus on more clinically complex primary care," the report notes.

It's also generally believed that greater use of NPs and PAs might save healthcare dollars. However, the increase in office visits to NPs and PAs did not result in cost savings, the HCCI analysis found.

Since 2012, the average cost of an office visit to a PCP remained closely aligned with the cost of an NP and PA visit. In 2016, the average cost per visit to a PCP was $106 compared with $103 for an office visit to an NP or PA.

The complete report and detailed methodology are available on the HCCI website.

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