Primary Care Access and Telemedicine Use in Medicare

Key Takeaways

• Primary care access declined over the study period among traditional Medicare beneficiaries.
• In 2023, virtual visits accounted for 7% of primary care visits, and 14% of beneficiaries with primary care access used telemedicine.
• Access gaps by race, geography, and income increased slightly, while continuity fell overall and was slightly higher among telemedicine users in 2023.

Primary care use fell across 258,324,127 person-years among traditional Medicare beneficiaries from 2017 through 2023, investigators found. Visit rates declined from 2.54 per person-year in 2017 to 2.27 in 2023 over seven study years. The analysis tracked both in-person and virtual primary care across the full period, rather than focusing only on pandemic-era use.

This serial cross-sectional analysis used 2017-2023 100% claims and administrative data for traditional Medicare beneficiaries who were continuously enrolled and alive for the given year. Researchers examined trends in primary care use and telemedicine's role in access and disparities. The analysis considered both virtual and in-person primary care visits when assessing access. Primary care access meant at least one virtual or in-person primary care visit during the year, and continuity was measured with the Bice-Boxerman Index.

Primary care access decreased from 61.9% in 2017 to 59.8% in 2023, extending the decline beyond visit frequency alone. In 2023, virtual visits comprised 7% of primary care visits, and 14% of beneficiaries who accessed primary care used telemedicine. Telemedicine use persisted, but it accounted for a minority of encounters and beneficiaries. In the final study year, it represented a limited share of overall primary care activity.

From 2019 to 2023, disparities in primary care access by race, geography, and income increased slightly. Among beneficiaries who accessed care, historically underserved groups were more likely than others to use telemedicine for that access. Primary care continuity declined from 0.72 in 2019 to 0.65 in 2023, although continuity in 2023 was slightly higher among telemedicine users than nonusers. The comparison contrasted beneficiaries who used telemedicine for primary care with those who did not.