Medicare preventive visits have been increasing for over 20 years

Primary care visits for preventive services have nearly doubled since 2001, and new research suggests that these visits give clinicians and patients more valuable time together.

The share of primary care visits directed at preventive services increased from 12.8% in 2001 to 24.6% in 2019, according to findings from a cross-sectional study of primary care visits among adults published this month in Health Affairs.

Increases over time continued across all age groups and insurance types, including private insurance, Medicaid, self-pay, and workers’ compensation. Medicare beneficiaries showed the largest increase in preventive visits, up 10 percentage points over a two-decade period.

The increase is likely related to policies enacted under the Affordable Care Act, which made preventive exams a unique type of visit without co-pays for Medicare and most other insurance plans, according to the researchers. The data showed a sharp increase in preventive visits for patients aged 18 to 44 shortly after the law was passed.

But “other factors in our health care system could have moderated the impact of the policy,” said Lisa Rotenstein, MD, a primary care physician at the Center for Primary Care at Harvard Medical School in Boston, who is the study’s lead author.

National trends show that fewer Americans have primary care physicians, and those who do see these specialists less often than in previous decades. In addition, the primary care workforce is shrinking, even as more nurse practitioners and physician assistants join the specialty.

“I’m surprised and pleased,” said Ann Greiner, president of the Primary Care Coalition, an organization that works to expand access to primary care.

Although the study in Health Affairs did not examine trends in primary care visits overall, the researchers highlighted several findings from previous research that found a decline in these visits. That survey also found that there were fewer adults who had a usual source of primary care.

“We know there is a decline in primary care visits, where preventive care happens,” Greiner said.

A new study, which used data from the National Survey of Ambulatory Medical Care, found that doctors spend significantly more time with patients during preventive visits compared to problem-based visits.

Physicians were also significantly more likely to counsel patients, order preventive labs, or order a preventive imaging or procedure during these visits. Nurse visits or physician assistant visits were not included in the study.

Christina Breit, MD, a primary care physician at Norton’s Medical Group in Louisville, Kentucky, said she typically spends 30 to 40 minutes performing a physical exam compared to just 10 or 15 minutes during an acute visit.

“When they come in for a preventive visit, we really understand the social determinants of health,” Breit said.

During this lengthy conversation about the patient’s health risks, preferences, and daily routine, Breit begins to understand all the red flags she would have missed in a 10-minute acute care appointment, which helps guide care decisions.

In addition to the well-established benefits of preventive care, the extended time fosters an improved doctor-patient relationship, Rothenstein said. Longitudinal doctor-patient relationships are associated with lower patient costs and hospitalizations.

“It should be one of our primary goals to use preventive care to stop chronic disease,” said Diane Thieris, NP, a family nurse practitioner in Columbia, Kentucky.

During the past 20 years of her 35-year career, she has been able to devote more time to these visits with adequate compensation, she said. In the spring of 2023, it began providing home wellness visits for Medicare enrollees.

“There has definitely been a long overdue increase” in preventive care visits over the past 20 years, Thierry said. Medscape Medical News. “Prior to that, the visits were focused on the main complaint of the day.”

But the increase in the number of preventive visits may also reflect the fact that patients are seeking other specialists for different diseases.

“Some of the simple problem-based visits have actually left primary care,” said Tim Anderson, MD, MAS, a primary care physician and health services researcher at the University of Pittsburgh. “The results may be indicative of the migration of ear infections and sore throats to urgent care and small clinics in pharmacies, for example.”

Although urgent care clinicians typically don’t have medical records or patient histories, this setting can be more accessible and convenient, Greiner said.

One limitation of the study is that it only assessed trends through 2019. The COVID-19 pandemic has placed intense stress on primary care clinicians and limited access to this care.

“Will we continue to see an increase in preventive visits? We’ll have to watch and see,” Greiner said.

The study was independently supported. Rothenstein and Maffy report no relevant financial relationships. Landon reports receiving consulting fees or payment from Freedman Healthcare Consulting, the American Board of Internal Medicine, RTI, Inc, UptoDate, Upstream, and CVS.

Donavin Coffey is a freelance science and health journalist. You can find more of her work here.

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