October 10, 2019

MedPAC Sees PCP Numbers Fall as Prevalence of Hospitalists Grows

The Medicare Payment Advisory Commission (MedPAC) heard staff presentations on the adequacy of Medicare payments for physician and other health professional services, as well as on two population-based outcome measures of avoidable hospitalizations and emergency department visits at its October 3–4 meeting.

During the first afternoon session, MedPAC staff members presented data showing growth in number of hospitalists and a decline in primary care physicians (PCPs) that they attributed to the implementation of the hospitalist specialty designation in 2017. Despite these changes, staff explained that Medicare beneficiary access to primary care has not changed.

MedPAC staff recommended altering the method for counting the number and type of clinicians who provide services to beneficiaries by separating hospitalists from the count of PCPs. It also proposed new analyses to replace the current volume analysis that account for complexity and shifts in site of service.

MedPAC staff concluded there is not an access issue with PCPs for beneficiaries, but there is concern about declining numbers of practicing PCPs and PCPs in training. Commissioners discussed the difficulty in determining a variable to measure access, as well as the role of nurse practitioners and physicians assistants who provide primary care.

The second afternoon session discussed two population-based outcome measures: avoidable hospitalizations and emergency department visits, which were translated into claims-based, risk-adjusted outcome measures.

MedPAC staff applied these measures and calculated risk-standardized rates for both MedPAC market areas and hospital services areas. MedPAC staff will share these results in in commission’s March report to Congress to identify areas for improvement and variations in performance and quality among different areas, such as fee for service, Medicare Advantage and accountable care organizations.

The commission will meet again in November.