What Are Primary Care Groups?

Helen Akers

Primary care groups are organizations that contain a network of primary care physicians. They are somewhat analogous to health care maintenance organizations (HMOs) that form a larger network of medical service providers. The main difference is that physicians in primary care groups specialize in internal medicine and can be thought of as general doctors, not specialists. In addition, these groups are usually smaller than an HMO and may operate one or two locations in a specific area. Doctors in these groups often have access to centralized billing and record keeping, coverage for absences from other group physicians, negotiated payments with insurance companies, and shared marketing and operating costs.

Primary care groups share costs, offices, staff, and call to serve patients.
Primary care groups share costs, offices, staff, and call to serve patients.

One of the characteristics of primary care groups is that they a create a centralized billing system for multiple, independent doctors. These groups of doctors may decide to take the same types of insurance plans as acceptable forms of payment. Patients of different physicians who operate under the group typically travel to the same location to receive medical services. Appointment scheduling and patient record keeping is usually handled by a central office or staff for all of the doctors in the group's network.

In some cases, doctors in primary care groups may share patient case loads under special circumstances, such as extended absences or retirements. For example, in the case of an urgent test or diagnosis, a physician in the group may agree to treat another doctor's patient while he is on vacation. Primary care physicians (PCPs) administer general non-emergency health care, including routine physicals, blood work, disease diagnosis, and follow-up treatments. Some examples of follow-up work are burn treatments, preventative shots, and administering prescriptions.

Another characteristic or function of primary care groups is that they tend to discount the cost of the doctors' services if the patient stays within the network. This discount is usually taken off the amount charged to the insurance carrier or shows up as a "negotiated fee" on the patient's final statement. Depending upon the patient's individual coverage, he may be required to seek medical care through a designated PCP and obtain referrals to specialists within the group's network in order to avoid paying full price.

Doctors who join primary care groups share marketing and operating costs with each other, while benefiting from word-of-mouth referrals. One of the strategies behind these types of networks is efficiency and shared reputation. For new primary care physicians who do not yet have many patients, joining a primary health care group can give them access to additional resources. Several of these groups often have a variety of doctors on staff with different experience levels, knowledge, and case loads.

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