Primary Care Physicians are the New Backbone for Health Care. Has the Time Come to Abandon the CPT Code?

Thomas Schwieterman 

Primary care physicians (PCP) have been identified as a critical part of the future health care value chain. Yet, we know we have far too few of them. We also know that independent providers are struggling financially.  As a result, a large number of primary care docs, perhaps a majority, have chosen to become employees of larger health systems. Most physicians label ‘salary’ as the top reason for becoming an employed clinician rather than trying to compete as an independent practitioner. But, with a CPT driven foundation for reimbursement, can this marriage between primary care and large health system be a healthy one?

When a PCP joins a health system and begins to receive a regular salary, the payments are often above that physician’s prior experiences in private practice, perhaps higher than could be reasonably calculated from the their daily productivity.  CFO’s are willing to accept the scenario of primary care salaries exceeding productivity, because they are keenly aware that the primary care physician acts as a feeder for the more lucrative profit centers at the hospital. Specialists and their ancillary staff perform most of the profit generating procedures, imaging studies, pathology examinations. These high priced resources need patients (and their insurance cards) to generate the margin-rich revenue for the financial viability of the health system.

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