Allergy Isn’t Ancillary
One of the most diagnostic indications that primary care isn’t doing enough about allergy is that allergy candidate detection, testing, and treatment is so often described as “ancillary” to a primary care practice. It isn’t. Detecting patients with potential undiagnosed allergies, testing them, and treating where appropriate, is core primary care—or it certainly ought to be. Comparison to other conditions considered central to primary care might be persuasive on this subject, but the statistics make this conclusion inescapable.
Allergy is no side hustle, but they call it that anyway
Describing an allergy program as “ancillary” to primary care is as common as it is wrong. Even the American Academy of Otolaryngic Allergy, for whom allergy is obviously the very center of existence, describes “allergy as an ancillary service” and an “addition to your practice as an otolaryngologist” rather than the heart of it
Multiple allergy providers to primary care clinics also call it ancillary. United Allergy Services, perhaps the prominent provider of third-party allergy programs {link to models} for primary care clinics, routinely calls itself an “ancillary service provider.” The call to action on their providers page is to “expand your practice with allergy ancillary services.” In fact UAS calls itself “Your Ancillary Services Provider.” That might be an unavoidable artifact of selling a third-party staffing model, but Oasis Allergy Solutions, a turnkey provider, also encourages physicians to “enhance patient care by adding ancillary allergy services.”
In fact, firms that serve PCPs but have nothing to do with allergy describe allergy as ancillary. Coronis Health, for instance, is a revenue cycle manager who asks “should your practice offer allergy treatment as an ancillary service,” describing it as “a good add-on.” In this case of a revenue manager it’s because allergy is such a fertile source of revenue, no doubt, but that doesn’t make it correct.
The commonality of this usage portrays allergy as extra, a nice to have, even a side hustle. That’s a grave misrepresentation of medical and statistical reality.
Allergy is core primary care; more common than nine of the top ten reasons to visit a PCP.
It’s very strange indeed to think of allergy as a side hustle when rarer conditions, by far, are among the top ten reasons patients visit their primary care providers. Definitive Healthcare (DHC) is the current owner of the Health Information and Management Systems Society (HIMSS) database and has further, continuing access to Medicare, Medicaid, commercial payor, and claims clearinghouse data regarding virtually all primary care visits across the United States. According to DHC, four of the top ten reasons patients see their primary care doctor, measured by, and in order of, prevalence of diagnostic codes in billing, are:
- High blood pressure management
- High cholesterol management
- Type 2 diabetes management
- Hypothyroidism (fatigue, weight management)
Primary hypertension affects 49.1% of the US adult population.i High cholesterol affects around 11.3%ii of US adults. T2D affects roughly 12%iii Hypothyroidism affects 20% at the high end.iv With children included, obviously, all of those figures shrink by a considerable margin.
With the exception of high blood pressure, and even without including children, every one of these figures is substantially less than the prevalence of diagnosed allergy. Perhaps needless to say, adding undiagnosed allergy raises its prevalence. Indeed, according to the World Allergy Organization, allergy is approaching 50%, which would put it a tick higher than hypertension. So why on earth would allergy be considered “ancillary” to primary care? It’s at the top of the prevalence list!