ArticleFamily medicine2026
The Primary Care Exception During and After a Public Health Emergency.
Article in Family medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesThe Primary Care Exception (PCE) in US graduate medical education allows billing for low complexity outpatient primary care visits with indirect faculty supervision, where the faculty does not directly see the patient. The PCE historically applied only to lower complexity billing codes; but during the COVID-19 public health emergency (PHE) from March 2020 to May 2023, the PCE was expanded to include moderate and high complexity visits. Prior PCE studies have evaluated family medicine residencies before the 2021 update to the Evaluation and Management Services guidelines, which include different definitions of complexity. This is the first study to evaluate the billing impact of PCE in a primary care residency of internal medicine after the Evaluation and Management Services update.
methodsWe conducted a retrospective billing data evaluation of 99213, 99214, and 99215 billing codes from July to September 2022 (during PHE) and July to September 2023 (post-PHE) in a single institution internal medicine residency clinic. We assessed the frequencies using χ2.
resultsA total of 11,358 patient visits met criteria. During the PHE, the majority were billed 99214 (4,602 of 5,557, or 82.8%) followed by 99213 (870 of 5,557, or 15.7%). Post-PHE, the majority were 99213 (4,000 of 5,801, or 68.3%) followed by 99214 (1,742 of 5,801, or 30.6%).
conclusionsWe observed an absolute 52.2% higher use of 99214 during the COVID-19 PHE expansion of the PCE. This finding has important implications for both clinic operations and education.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.