Impact of Primary Care Exception Expansion on Family Medicine Resident Billing During the COVID-19 Pandemic

Area of Science:

• Medical Education
• Health Policy
• Primary Care

Background:

• The Medicare Primary Care Exception (PCE) traditionally allowed indirect supervision for lower-complexity resident visits.
• During the COVID-19 pandemic, Medicare expanded the PCE to cover all patient visit complexities.
• This expansion aimed to support healthcare delivery during a public health crisis.

Purpose of the Study:

• To investigate the impact of the expanded Medicare Primary Care Exception (PCE) on resident billing practices.
• To compare billing patterns of residents and attending physicians before and after PCE expansion.
• To assess the hypothesis that residents would increase high-level billing when not constrained by PCE complexity limits.

Main Methods:

• Data from established evaluation and management visits at a family medicine residency were queried for calendar year 2020.
• Billing codes for residents and attending physicians were analyzed.
• Chi-squared tests compared resident and attending use of low/moderate vs. high-level billing codes quarterly.

Main Results:

• Resident high-complexity code use significantly increased in Q4 2020 post-PCE expansion (OR 3.50) compared to Q1.
• No significant change in high-complexity code use was observed among attending physicians (OR 1.05).
• Resident and attending physician billing patterns converged after the PCE expansion.

Conclusions:

• Senior residents adopted higher-complexity billing codes at rates similar to attending physicians following PCE expansion.
• Findings suggest implications for the financial sustainability of primary care residency programs.
• Further research is needed on replication, educational impact, and patient outcomes of PCE expansion.