Using State All-Payer Claims Data to Identify the Active Primary Care Workforce: A Novel Study in Virginia

In response to the inquiry by Mr. Rozehnal and Dr. Wallace’s comments, thank you for reading and engaging! We apologize for the tardy response. We used a wellness visit approach for this analysis as it is unique to, but not ubiquitous for, primary care. We identified many family physicians who coded for well over the 10 count of wellness visits annually. However, some family medicine physicians coded no wellness visits in a year - so wellness visits are likely imperfect, but acted here as a surrogate marker for primary care until a more complex and comprehensive set of codes could be distilled that capture the true nature of family medicine.

As for the count of 10 wellness visits, we found a similar cohort of results with 10% of visits versus 10 numeric visits – and we hoped to be inclusive of all primary care clinicians, even those with few wellness visits. Population density did not have a significant impact on the numeric count of 10 – primary care physicians practicing in rural areas followed the trend of at least 10 wellness visits if any were coded at all.

We recognize your question address the concept that care provided in rural communities may not be eidetic to that in urban communities, so the same rules may not be followed in these areas. We agree! There is likely a combination of CPT/ICD-10 codes and/or E&M codes that best describe your typical family physician in various settings, including rural, academic, or urgent care. Figuring out these codes is the trick! Perhaps you can help identify the key!