Preventive Care Visits Among Medicare Beneficiaries Grew, Study Finds

The share of primary care visits focused on preventive care nearly doubled between 2001 and 2019, with the steepest growth among Medicare beneficiaries, a Health Affairs study found.

Periodic preventive visits can help establish longitudinal patient-provider relationships and improve intermediate health outcomes, such as cholesterol, blood pressure, and body mass index. However, some stakeholders have questioned the value of preventive visits and how often they should occur.

Researchers used data from the 2001-2019 National Ambulatory Medical Care Survey (NAMCS) to determine how the share of primary care visits with a preventive focus has changed over time and how the issues addressed at these visits compare with problem-based primary care visits.

The sample included 139,783 unweighted primary care physician office visits between 2001 and 2019. Over half of the visits were paid for by private insurance, while 28.9 percent were paid for by Medicare, Medicaid, workers’ compensation, or self-pay. The share of primary care visits for people with Medicare grew from 27.6 percent in 2001 to 37.7 percent in 2019, the study noted.

The percentage of primary care visits with a focus on preventive care increased from 12.8 to 24.6 percent between 2001 and 2019. The growth occurred among all age groups and people with all insurance types, but Medicare beneficiaries saw the greatest slope of increase.

These changes led to an increase in the prevalence of preventive visits in the US, rising from 295.9 visits per 1,000 people in 2001 to 463.2 visits per 1,000 people in 2019. The greatest increase was seen among people 65 and older.

Meanwhile, the prevalence of problem-based visits fell from 2,017.5 to 1,416.7 visits per 1,000 people.

Primary care visits focused on preventive care were significantly longer than problem-based visits throughout the study period. At the same time, there were more reasons for a visit addressed in problem-based visits than preventive visits.

During preventive visits, physicians were more likely to provide counseling related to diet and nutrition, exercise, tobacco mental health, psychotherapy, or stress management. Counseling was provided during 26.5 percent of preventive visits compared to 24.2 percent of problem-based visits.

Primary care physicians were also more likely to order screening labs during preventive visits than problem-based ones. Between 2018 and 2019, preventive labs were ordered in 33.2 percent of preventive visits compared to 18.4 percent of problem-based visits. Preventive images or procedures were more common during preventive visits, as well, the study noted.

The growing prevalence of preventive visits could lead to more time for primary care physicians to provide patients with evidence-based counseling and other preventive services. However, fewer Americans have a primary care physician and see them less frequently over time. Researchers said this makes it unclear if this additional time offsets the time impact of Americans having fewer interactions with their physicians.

In terms of policymaking, the findings suggest an association between insurance designs and preventive care delivery.

The study also suggests that insurance coverage policies helped improve access to preventive care. For example, the Affordable Care Act (ACA) started requiring Medicare to fully cover patients’ annual preventive exams in 2011. This is also likely behind the steeper increases in preventive visits among Medicare beneficiaries.