Medicare Outpatient Care Becomes More Fragmented

For many reasons, outpatient medical care has shifted substantially from primary care to specialist visits during the past few decades. In a large, cross-sectional study, investigators used Medicare claims data from 2000 to 2019 to assess outpatient visits with primary care providers (PCPs) — internists, family practitioners, geriatricians, or nurse practitioners — and with distinct specialty physicians.

Only two thirds of all Medicare beneficiaries saw any PCP in 2019. From 2000 to 2019, the mean number of annual PCP visits remained unchanged (3), whereas the mean number of annual specialist visits increased by 20% (from 4 to 5). The proportion of patients who saw five or more specialist physicians annually increased significantly (from 17%…