Essential Office Procedures for Medicare Patients in Primary Care: Comparison With Family Medicine Residency Training

Demographic trends show an increasing older adult population. Therefore, family medicine training programs may need to reevaluate how well their residents perform clinic procedures essential to older adults. Our objective was to compare the rates of the most frequently performed clinic procedures for Medicare patients in a large multiregional health care system (MRHCS) with those in a family medicine residency clinic.

In this retrospective cohort study, Current Procedural Terminology coding data were queried from the billing systems of an MRHCS (the control group) and a family medicine residency clinic (the study group) for a 3-year period. The primary outcome was the procedural rate ratios per 1,000 office visits for the 10 most common clinic procedures in the MRHCS billed to Medicare.

The study group consisted of 19,099 office visits by Medicare patients to the residency clinic; the control group consisted of 2,034,188 visits to the MRHCS. Except for large joint injection, procedural rates were significantly different for the other nine procedures (destruction of benign skin lesions, nail care, punch or shave skin biopsy, removal of impacted cerumen, wound debridement of skin, Unna boot application, excision of skin lesion, paring of corn or callus, and insertion of bladder catheter). The rate of skin excision was higher in the residency clinic than in the MRHCS but lower for the other eight procedures.

These data suggest that teaching programs may need to adapt to meet the current and future practice needs of this increasing patient population.