Reason 5: Primary care research to identify, implement, and track care delivery and payment solutions is lacking.

Methods Note: Data Limitations

As noted in the report, the data sources available to track primary care are incomplete. We outline here the data needs that we have identified while preparing the Scorecard.

Workforce and Access Data

• A “minimum data system” for the nonphysician workforce in primary care, in particular, for NPs and PAs. This should includecurrent specialty of practice, current address, and clinical hours worked (in full-time equivalents). The development of such a measure will require collaboration across state boards and across each professional organization.
• An up-to-date data set for physicians of all specialties with current address of practice, current specialty, and clinical hours worked (in full-time equivalents). These data are already collected by state boards during licensing and renewals of licensing, but need to be harmonized between states and released to the public as in a “minimum data system.”
• A more robust data set that collects information about multidisciplinary or interdisciplinary health care provider team composition, services provided, and the demographics of patients. These data are already collected by boards such as the American Board of Family Medicine but need to be expanded to other specialties and harmonized into a “detailed data system.”
• National data on wait times for primary care clinicians, including initial and follow-up appointments. Each health system collects these data separately, but no national repository exists. At a minimum, hospital systems that receive federal funding (i.e., GME dollars) should be required to report this type of data into a national registry.
• Patient-level data on primary care access and experience. Data from Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys or equivalent should be harmonized at a national level and made publicly available.
• Clinician-level data on practice experience and measure of workforce well-being. These data should be collected at a national level for any health system that uses federal or state (Medicare/Medicaid) dollars.

Training Data

• Data on the clinical settings where nonphysicians train. The specialty of the training locations, the address of each training location, and hours worked in each setting should be collected and made publicly available.
• Longitudinal data on Teaching Health Center programs. Data such as years in service and number of residents trained in each year should be made publicly available on the Health Resources and Services Administration (HRSA) website.
• Data on training outcomes. Data such as percentage of residents working in areas of disadvantage and the percentage of residents working in outpatient settings should be collected by institutions that receive federal funding (CMS, Department of Veterans Affairs [VA]) and reported annually; this can be derived entirely from existing data without any additional burden for teaching hospitals.

Payment Data