04/04/2026
An article from Becker (from a report by Health Affairs in March) was noting how Primary Care Physician compensation is finding even more hurdles, as more of the medical spending is on surgical and other procedures. I thought you would find this interesting given most of YOU are specialists as opposed to being the patient's P*P, especially in personal injury.
Here are 10 things to know:
1. Primary care physicians’ share of total Medicare spending is shrinking. P*Ps’ share of fee schedule spending dropped from 18.6% in 2017 to 15.9% in 2023.
2. The 2021 fee schedule reforms failed to help P*Ps. CMS increased office visit fees, reduced documentation burdens and added new care management codes, but none of this translated into a larger share of payments going to primary care physicians.
3. Evaluation and management fee increases benefit everyone. Primary care physicians account for only 28% of total E&M spending. Surgical and procedural specialists, nurse practitioners and other non-procedural specialists collectively capture the majority.
4. P*Ps only capture around 29% of office visit spending. Despite office visits being the backbone of primary care, most of that billing is done by other specialties, further diluting the intended benefit of fee increases.
5. E&M codes dominate P*P revenue. Because P*Ps rely so heavily on E&M billing compared to other specialties, with E&M codes accounting for 92.5% spending accounts of Medicare payments, they are disproportionately hurt when those fees don’t keep pace with overall growth.
6. Total Medicare spending on P*Ps fell in absolute terms. It dropped from $17 billion in 2017 to $14.4 billion in 2023, even as total fee schedule spending held flat at about $91 billion.
7. Care management codes have historically underperformed. Past attempts to compensate P*Ps for non-visit activities like care coordination and patient messaging through special codes saw low adoption. New 2025 “advanced primary care management” codes face the same uncertainty.
8. P*Ps perform significant uncompensated work. Activities like patient messaging, care coordination and remote monitoring are not easily reimbursed under fee-for-service, putting P*Ps at a structural disadvantage.
9. Medicare Advantage enrollment is masking the true scale of the problem. The paper notes that the growing share of beneficiaries enrolled in Medicare Advantage are not captured in traditional Medicare fee-for-service claims data.
10. A hybrid payment model is the most promising solution. The authors recommend combining population-based payments (to cover uncompensated activities for all attributed patients) with a separate conversion factor specifically for primary care, rather than continuing to rely on broad E&M fee increases.
Evidence suggests that primary care physicians spend more time than other clinicians on activities that the fee schedule does not reimburse at all. A hybrid approach that incorporates population-based payments into the fee schedule to cover these non-paid activities for all patients attributed to th...
