Primary care use fell across traditional Medicare
Primary care has long been treated as the front door to the US health system, especially for older adults managing chronic illness, medications, and preventive care. New research in JAMA Health Forum suggests that door has been opening less often. In a serial cross-sectional study using 2017 to 2023 claims and administrative data for traditional Medicare beneficiaries, researchers found that both visit rates and overall access to primary care declined over the period.
The study covered 258,324,127 person-years and found primary care visit rates fell from 2.54 visits per person-year in 2017 to 2.27 in 2023. The share of beneficiaries who accessed primary care also dropped, from 61.9% to 59.8%. Those shifts may look modest on paper, but at Medicare scale they point to millions of foregone visits in a system already under pressure from workforce shortages, changing practice patterns, and administrative complexity.
Telemedicine helped, but did not replace lost access
One of the most closely watched questions in post-pandemic medicine has been whether telemedicine can preserve access when in-person systems are strained. The findings here suggest it helped some patients, but not enough to reverse the larger decline. Virtual visits accounted for 7% of primary care visits in 2023, and 14% of beneficiaries who accessed primary care used telemedicine to do so.
That matters because telemedicine is often discussed as a broad fix for access problems. This analysis points to a narrower reality. Virtual care has become part of the mix, but it remains a minority channel for primary care in Medicare. It can reduce friction for some patients, especially those facing transportation barriers or limited local clinician supply, yet it has not offset the overall erosion in access seen across the study period.
Continuity also moved in the wrong direction
The data show a second warning sign beyond simple visit counts: continuity of care worsened. From 2019 to 2023, primary care continuity declined from 0.72 to 0.65. Continuity is important because patients with an ongoing relationship to the same clinician or care team are generally better positioned for medication management, follow-up, and early detection of complications.
Interestingly, continuity in 2023 was slightly higher among those who used telemedicine for primary care. That does not mean virtual care solves continuity on its own, but it does suggest remote visits may help some beneficiaries stay connected to an existing clinician relationship rather than fragmenting care further.
Disparities appear to be widening
The study also found a slight increase in disparities in access by race, geography, and income from 2019 to 2023. That is especially significant because older adults in historically underserved communities often face multiple barriers at once, including transportation challenges, fewer nearby clinicians, and more limited access to specialist networks. Researchers noted that beneficiaries in underserved groups who did access primary care were more likely to do so through telemedicine.
That finding cuts two ways. On one hand, it suggests telemedicine can play a meaningful role in connecting patients who might otherwise struggle to get care. On the other, it reinforces that digital care is arriving in a system where underlying inequities remain unresolved. If payment policy or reimbursement changes make virtual access harder to sustain, the consequences may not fall evenly.
Why this matters for Medicare policy
The authors said the results likely reflect shifting primary care workforce and practice patterns, and they pointed to implications for Medicare telemedicine reimbursement and broader primary care payment reform. That policy context is central. If older adults are seeing primary care less often, and if continuity is weakening at the same time, the downstream effects could include more avoidable complications, poorer chronic disease control, and heavier use of higher-cost settings later.
The study does not claim telemedicine is the primary answer, nor does it present primary care decline as a single-cause problem. What it does offer is a clear signal that access is moving in the wrong direction for a population that depends heavily on regular, coordinated outpatient care. For policymakers, the message is less about novelty than urgency: primary care capacity, continuity, and reimbursement rules now look increasingly linked to whether Medicare beneficiaries can actually get the routine care the program is designed to support.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
