The primary care practice crisis: It’s time to play offense

It is hard to miss the headlines about the unprecedented challenges threatening family and internal medicine across the primary care spectrum, from independent physicians considering leaving private practice to administrators of larger medical groups and health systems. This traditional and essential gateway to health care in the United States is buckling due to:

1. Crushing administrative burdens from payers
2. Accelerating costs exacerbated by inflationary pressures
3. Anemic reimbursement rates that don’t keep pace with the first two threats
4. Emerging competitors blurring the primary care sector for patients, such as telehealth platforms, wellness and weight loss organizations, and mega companies such as CVS, Walgreens, United/Optum Health and Amazon.

Brad J. Scoggins, DO, FAAP

Playing defense against such significant threats is not only a natural reflex; it is essential. Most practices are doing everything they can to streamline administrative workflows and leverage technology, manage supplier costs and the revenue cycle, and negotiate the best possible contracts with payers.

However, in today’s world of rapid-fire patient visits with limited time to diagnose, treat and counsel, it is common for primary care practices to refer patients out for services that they don’t offer, along with the revenue those treatments represent. Patient leakage due to referrals of services that a primary care practice can and should provide in-house is a key cause of stress on independent and large group primary practices alike.

That brings us to the offense section of the primary practice playbook. The same that’s true in sports and business is true in primary health care — you’ve got to play an aggressive offense to win. When primary care practices are being strangled by market forces beyond their control, the fastest way to counter those forces is to quickly generate more revenue. Assuming a practice is effectively delivering all the routine core primary care treatments and services, it is time to expand into ancillary medical services and the additional revenues and other benefits they represent.

Ancillary medical services and not-so-ancillary revenue, satisfaction, retention

A great place to ramp up quickly is offering embedded clinical services from an established specialist partner that comes with the embedded staff, supplies, and access to specialty medications that can be integrated into the practice’s clinical, operational and financial workflows.

As an ancillary medical services case example, let’s look at allergy care as an opportunity for primary care practices to diversify services, meet growing patient demand, keep patients within the practice, and generate substantial new revenue.

For starters, the market is clearly there. Nearly one in three U.S. adults and more than one in four U.S. children reported having a seasonal allergy, eczema or food allergy in 2021, according to data from the Centers for Disease Control and Prevention National Center for Health Statistics, and almost 6% of U.S. adults and children have a food allergy.

Primary practices that are offering ancillary allergy services to their patients are not only capturing a larger share of patient health care spend and alleviating reimbursement pressures, but on average a practice could consistently generate an additional $150,000 to $250,000 yearly (based on practice size and payer mix). Oftentimes, that revenue range is equivalent to what an additional physician could produce for the medical practice, but with a much smaller footprint and administrative cost.

The substantial revenue bump aside, those primary practices are providing better, more coordinated care and quality outcomes at lower costs than if they referred their patients to an allergy specialist nearby. Their patients experience improved quality of life, they’re happier and more satisfied, all of which makes them loyal to the practice and more likely to refer others.

How to integrate ancillary medical services into the practice: the allergy example

Primary care practices that want to quickly offer ancillary allergy solutions to their patients can partner with an established allergy specialist group that can provide the staff, supplies, equipment and access to compounding pharmacy services. At the same time, the practice should insist on maintaining full clinical control, and the allergy staff person should integrate seamlessly into the practice’s existing workflows. The program should have the following core framework:

Going on offense

Primary care practices are facing an unprecedented crisis driven by ever-increasing administrative burdens, rising costs, stagnant reimbursement rates and margins, and new competitors. While defensive measures like optimizing workflows and managing costs are crucial, they are not enough to secure the survival and prosperity of these essential health care physicians.

To truly thrive in this challenging environment, primary care practices need to play offense and expand into clinically relevant and financially lucrative ancillary medical services. This approach not only generates additional revenue but also enhances patient satisfaction and retention. A prime example is in-house allergy care, which addresses a significant patient need while boosting practice revenue by an estimated $150,000 to $250,000 annually.

Implementing ancillary allergy services can be done swiftly and effectively through partnerships with established allergy specialists. These collaborations with allergy partners bring in the necessary expertise, supplies, and staff, ensuring seamless integration into existing practice workflows. By maintaining clinical control while the ancillary services partner provides comprehensive patient education, administrative support, and access to advanced treatment options, primary care practices can offer high-quality, coordinated care that keeps patients within the practice.

In conclusion, the path forward for primary care involves playing offense: diversifying services, embracing innovative revenue streams, and ensuring superior patient care. By doing so, primary care practices and medical groups large and small can emerge stronger, more resilient, and better equipped to meet the evolving needs of their patients.

Brad J. Scoggins, DO, FAAP, received his undergraduate degree in forensic science from Baylor University in Waco, Texas, and his doctor of osteopathic medicine from Kirksville College of Osteopathic Medicine in Kirksville, Missouri. He completed a pediatric residency at the University of Texas Health Science Center in San Antonio, Texas. His background also includes pre-hospital emergency medicine, life support training, and fieldwork as a paramedic. Currently he is a pediatrician and medical director at San Juan Health Pediatrics.