Primary care physicians must identify and manage a wider range of conditions than most other specialists, introducing a high degree of complexity into their practice. Because of this, payers and policy makers should revisit payment criteria to ensure PCPs are properly compensated for the complexity of their work, according to the authors of "Accounting for complexity: Aligning current payment models with the breadth of care by different specialtiesspecialties," published by the Association of American Family Physicians.
According to the authors' analysis of data from the 2010 National Ambulatory Medical Care Survey, PCPs provide care for a larger number of diagnoses than other specialists. Further findings show that family physicians use at least 23 diagnostic codes to account for 50 percent of their coding, while only six diagnostic codes account for 50 percent of coding for cardiologists and only three diagnostic codes for psychiatrists.
The complexity of the care provided is usually associated with the number of tasks being managed and how they interact with each other. For example, managing a complex adaptive system, such as treating a patient with multiple conditions that interact or that require conflicting drug regimens, is more complex than managing a single chronic condition, according to the article. Therefore, the authors of the article contend CMS should account for the complexity of the care offered by primary care physicians and the time required to provide such care by changing the fee schedule used to pay physicians.