Abstract

The economic model for primary care in the United States in 2017 is still almost completely built upon a foundation of fee-for-service transactions (Berenson & Rich, 2010). Virtually all the revenues for primary care practices are for face-to-face encounters with a doctor (or nurse practitioner/physician assistant), with an arcane system of acuity coding to determine how much the payment is for each visit or for discrete procedures or tests administered. Not surprisingly, then, the entire delivery model is built on a transactional model. Doctors make every encounter into a visit because that is all they are paid for.