Decline in family physicians’ outpatient Medicare procedures amid aging demographic trends

Background and goal: Family physicians perform a wide range of procedures outside the hospital and tend to be office based. Examples may include surgical procedures such as excisions, suturing, and joint injections. Since the training can vary substantially, the Council of Academic Family Medicine (CAFM) issued a statement on which procedures they recommend physicians be able to perform competently upon completion of a family medicine residency. The aim of this study was to determine the extent to which family physicians perform CAFM-recommended procedures for Medicare Part B, the outpatient portion of Medicare. By documenting the procedural clinical activity of family physicians, the researchers set out to better understand their impact on U.S. primary care.  

Study approach: Using a publicly available dataset that contains use, payments, and submitted charges for Medicare activities, researchers matched Medicare patient encounter codes with CAFM-recommended procedures to analyze how often family physicians reported CAFM-recommended procedures in an outpatient setting from 2014 to 2021. The researchers classified procedure codes by organ system. 

Main results: In 2021, 9,410 family physicians filed 904,278 CAFM procedure claims for 444,309 patients.

• All (99.92%) of the mCAFM procedures reported in 2021 fell into the following five procedure clusters: skin (51%), musculoskeletal (36%), eyes, ears, nose, and throat (EENT) (9%), pulmonary (2%), and anesthesia (2%)
• Despite a slight uptick (2% to 6%) in skin, musculoskeletal, and anesthesia procedures between 2018 and 2019, there was a 33% decline in outpatient procedures filed and a 36% decline in the number of family physicians filing them between 2014 and 2021
• Only 12% of family physicians reported CAFM outpatient procedure claims in 2021. These claims represent less than 1% of all patient encounter codes submitted that year 

Why it matters: Fewer and fewer family physicians are billing for CAFM-recommended procedures. This trend is concerning as the U.S. population is aging. While procedures may increasingly be performed by physician assistants, nurse practitioners, or specialists after referral, this trend is still troublesome because it is likely to reduce access and convenience while increasing cost.