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Download the article PDF: Benefits Of Adding Primary Care Services To Your Urgent Care
Phyllis Dobberstein, CPC, CPMA, CPCO, CEMC, CCC
In the last few years, the Centers for Medicare & Medicaid Services (CMS) has accelerated its long-term effort to strengthen primary care as the foundation of the U.S. health system. Through new payment models, regulatory changes, and equity-driven initiatives, CMS aims to rebalance healthcare spending toward prevention, care coordination, and whole-person health. All these are areas historically underfunded compared to specialty or hospital care.
Major policy changes have been enacted through the Physician Fee Schedule (PFS), including increased payment for longitudinal and continuous primary care, introducing or expanding billing codes for community health integration, caregiver training, and social determinants of health (SDOH) risk assessments. These updates formally recognize the growing scope of primary care, aiming to correct long-standing financial distortions that favored hospital consolidation and procedure-based revenue over prevention and continuity of care.
The push toward advanced primary care reflects changing realities in healthcare delivery. Between 2000 and 2019, the share of Medicare beneficiaries seeing five or more physicians annually rose from 18% to 30%. During that period, the average primary care clinician had to coordinate with nearly twice as many other providers, jumping from 52 to 95.1
This fragmentation drives inefficiency, duplication, and burnout. CMS argues that primary care teams, supported by adequate funding, data tools, and flexibility, can help patients navigate the system more effectively. By addressing issues early, managing chronic illness, and linking patients to behavioral or social support, robust primary care can reduce avoidable hospitalizations and emergency visits.
CMS also notes that the U.S. spends less than 5–7% of total healthcare expenditures on primary care, compared with roughly double that share in many other high-income nations.2 Strengthening primary care, the agency believes, is essential not only for cost control but also for health equity and patient trust.
This “whole person” philosophy reflects a broader cultural change within Medicare and Medicaid policy. Rather than viewing social and behavioral factors as peripheral to medical care, CMS now treats them as integral components of health. The agency’s inclusion of SDOH assessments, caregiver support, and community resource navigation in payment structures is a concrete step toward operationalizing that belief.
Focus on Primary Care
CMS’s commitment to primary care reform is long-term and iterative. While implementation challenges remain, CMS intends to make primary care the central organizing principle of American healthcare. History shows us that private payers will follow CMS’s lead when creating their policies.
By investing in prevention, relationships, and community-based care, CMS is betting that a stronger primary care system will deliver healthier patients, more resilient providers, and a more sustainable Medicare program for the future. Meanwhile, urgent care operators are finding an opportunity to align with this trend by integrating primary care or running parallel, primary care services within their centers.
Urgent care has traditionally served as a convenient, episodic option for “working age” adults and their families who need quick treatment for illness or injury. However, this same demographic often lacks a regular primary care provider (PCP). Without routine wellness visits, chronic disease management, or preventive screenings, many patients miss key components of long-term health.
The national shortage of PCPs is deepening this gap. The Association of American Medical Colleges projects that up to 124,000 physicians could retire by 2024, nearly 48,000 of them in primary care, leaving underserved communities short by more than 180,000 providers.3 As demand outpaces supply, urgent care centers are strategically positioned to help fill the void by offering accessible, community-based care at extended hours and familiar locations.
Adding primary care services can create a parallel revenue stream while strengthening patient loyalty. Services such as annual physicals, immunizations, chronic disease follow-up, and preventive screenings naturally complement urgent care’s existing offerings. This approach allows centers to transition from one-time visits to ongoing relationships, turning occasional patients into long-term ones.
However, experts emphasize that urgent care and primary care operate differently. Urgent care focuses on high patient throughput, while primary care requires time-intensive visits and continuity. To avoid workflow conflicts, many operators are launching primary care as a separate but co-located entity. This model involves distinct payer contracts, billing systems, and provider teams while sharing the same facility. Patients experience a seamless environment, while the business gains operational clarity and sustainable growth.
By running primary care parallel to urgent care, centers can meet rising demand, expand community access, and capture new market, all without diluting their core mission. In an era when CMS is rewarding whole-person, value-based care, urgent care operators have a timely opportunity to evolve into front doors for comprehensive health.
References
- Barnett ML, Bitton A, Souza J, Landon BE. Trends in Outpatient Care for Medicare Beneficiaries and Implications for Primary Care, 2000 to 2019. Ann Intern Med. 2021;174(12):1658-1665. doi:10.7326/M21-1523
- Cohen DJ, Totten AM, Phillips RL Jr., et al. Measuring Primary Healthcare Spending [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2024 May. (Technical Brief, No. 44.) Executive Summary. Available from: https://www.ncbi.nlm.nih.gov/books/NBK604102/
- GlobalData Plc. The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. Summary Report. Washington, DC: Association of American Medical Colleges; March 2024.
