In most U.S. states, the percentage spent on primary care is less than half the average in Western European nations
to close to 50,000. Given the concentrated supply of primary care physicians in urban and suburban centers this will have a disproportionate impact on people living in rural areas, who are generally older, poorer, sicker, and less well-insured., the shortage of primary care doctors can be attributed to low numbers of residency slots, the salary gap between primary care doctors and specialists, and high rates of student debt which drive many into higher-paying specialties.
As an illustration, in May of this year the Centers for Medicare and Medicaid Services unveiled an initiative called the payment models, which CMS hopes to implement starting in January 2020. Primary care physicians can voluntarily sign up for the program. CMS asserts that these new payment models will reduce administrative burdens for primary care physicians, and
enable them to earn"performance-based payments" if they deliver care to Medicare patients that meets certain pre-determined targets that decrease downstream healthcare costs. However, what may deter some physicians from signing up is that the new payment models could actually increase their administrative burdens and practice costs. The CMS value-based payment models require a
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