A 6 minute read
doctor with stethoscope working on older man with heart pain
May 7, 2019

Primary care physicians (PCPs) are an integral part of the continuum of care. These providers are on the front lines of population health management and preventative care, gaining the trust of patients and their families to deliver effective, personalized care. A PCP is responsible for chronic care management, specialist and testing referrals, and evaluation for emerging health issues. Without a primary care physician, patients are at risk of receiving diagnoses at later stages of illness, which could impact care outcomes and mortality.

We’ve compiled the most common physician diagnoses using Definitive Healthcare’s platform on all-payor diagnoses and procedure data. All of the top three diagnoses are preventable with proper oversight by a primary care physician and are easily treatable if caught early. These conditions can also lead to complications such as heart disease (number eight on the list), nerve and kidney damage, and increased mortality risk if left undiagnosed or untreated.

Most Common Diagnoses for Primary Care Physicians

Rank ICD-10 Code ICD-10 Description # Diagnoses
1.   I10   Essential (primary) hypertension   18,599,408 
2.   E785   Hyperlipidemia, unspecified  7,295,102 
3.  E119   Type 2 diabetes mellitus without complications 5,974,288 
4.  Z0000   Encounter for general adult medical examination without abnormal findings 5,697,517 
5.  Z23   Encounter for immunization 3,911,694 
6.  E039   Hypothyroidism, unspecified 3,580,245 
7.  K219   Gastro-esophageal reflux disease without esophagitis 3,386,603 
8.  I2510   Atherosclerotic heart disease of native coronary artery without angina pectoris 2,945,075 
9.  E559   Vitamin D deficiency, unspecified 2,806,626 
10.  E782   Mixed hyperlipidemia 2,773,456 

Fig 1  Diagnosis data from Definitive Healthcare’s platform on commercial medical claims for physicians specializing in internal medicine. Intelligence is from CY 2018.

Immunizations were the fifth most commonly reported physician encounter in 2018, emphasizing the importance of PCPs in offering preventative medicine and population health management. With fewer parents opting to vaccinate their children, outbreaks of measles and mumps are occurring in more than 40 states. By providing immunizations for illnesses like the flu to eligible patients, PCPs can help curb preventable threats to population health.

As seen in the table below, the primary procedures performed by primary care physicians are blood tests and other diagnostic procedures. Without access to a PCP, patients are at risk of developing complex medical conditions that would otherwise be preventable or easily treated in the early stages. Hyperlipidemia, an excess of fat in the blood vessels, is the second most-diagnosed condition by PCPs, and is diagnosed via lipid panel (the fourth most common procedure). Undiagnosed, hyperlipidemia can lead to increased risk of heart attack, stroke, heart disease, and other illnesses.

Most Common Procedures for Primary Care Physicians

Rank HCPCS Code HCPCS Description # Procedures
1.  36415   Routine venipuncture 8,106,996 
2.  85025   Complete blood count w/auto diff white blood cell count 3,447,630 
3.  80053   Comprehensive metabolic panel  3,194,525 
4.  80061   Lipid panel 3,001,238 
5.  83036   Glycosylated hemoglobin test 2,379,597 
6.  93000   Electrocardiogram complete 2,061,629 
7.  97110   Therapeutic exercises 2,045,537 
8.  90471   Immunization administration 1,961,496 
9.  96372   Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular 1,812,679 
10.  84443   Assay thyroid stimulating hormone 1,731,461 

Fig 2  Procedure data from Definitive Healthcare’s platform on commercial medical claims for physicians specializing in internal medicine. Intelligence is from CY 2018. The list does not include “office/outpatient visits” (HCPCS codes 9921) and “subsequent hospital care” (HCPCS code 9923).

Despite the importance of having a PCP, 28 percent of men and 17 percent of women report having no personal physician. Nevada, Alaska, and Texas are the top three states with the greatest percentage of adults reporting that they have no PCP. This could be due to many factors, including physical barriers to healthcare access (such as transportation), insurance coverage, or provider shortage.

Definitive Healthcare found that internal medicine and family practice are the two most common physician specialties, with roughly 138,000 and 126,000 registered providers, respectively. Although this appears to be a large number of providers, industry leaders are still concerned that the demands of an aging population with a growing list of chronic health issues will outpace the number of physicians.

A study from JAMA Internal Medicine found that for every 10 additional PCPs per 100,000 patients, there was an associated life expectancy increase of nearly 52 days. However, between 2005 and 2015, the density of primary care physicians dropped from 46.6 to 41.4 per 100,000 people. This decrease in available physicians impacts some regions more than others – rural areas experienced a disproportionate loss, making an already-vulnerable population more susceptible to preventable illness.

In an effort to improve primary care provision, federal health officials announced CMS Primary Cares, a new program that will pay physicians who offer advanced preventative care. The initiative offers five payment options that allow providers to take on varying levels of financial risk to improve care outcomes and lower costs. Under the new program, physicians would receive financial rewards for enhancing care management for patients with chronic illnesses – like diabetes and hypertension — and avoiding hospital or ER admission.

This is one of many steps the Centers for Medicare and Medicaid Services (CMS) has taken to move U.S. healthcare to a value-based system rather than the existing fee-for-service model. Want to learn more about hospital performance in value-based purchasing and other CMS initiatives? Definitive Healthcare tracks clinical and quality performance for nearly 7,900 hospitals across the U.S. Sign up for your free trial today!

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