Sept. 12, 2023

By Tochi Iroku-Malize, M.D., M.P.H., M.B.A.
AAFP President

Facts may speak for themselves, but static easily drowns them out — especially when the truth is on your side. That’s why the AAFP is speaking out loudly about Medicare add-on Code G2211, and why your voice is needed, too.

As Stephanie Quinn, the AAFP’s senior vice president of advocacy, practice advancement and policy, told you recently, G2211 is a long-planned, straightforward and vital correction designed to appropriately pay for the comprehensive, longitudinal care we deliver. Its full implementation next year would improve primary care access for Americans and lead to better patient health outcomes. Yet G2211 has attracted attacks from some medical specialties, putting that implementation at risk.

These objections are static: noise from a status quo defined by decades of inadequate Medicare pay for primary care and longstanding misapprehension — even within the house of medicine — of primary care’s role and importance in our health care system. G2211 doesn’t solve the failures of investment and imagination that have arrested our workforce numbers and led to maldistribution of clinicians. However, it absolutely does affirm that policymakers grasp the criticality of our work, thanks to the AAFP’s advocacy.

The Academy is now turning its advocacy to face this wave of shortsighted hostility and push G2211 across the finish line. You can see some of this work on the Academy’s new G2211 page, which lays out our strong case for the code, dismantles several falsehoods being leveraged against it and includes a link to the AAFP’s Speak Out tool to help you contact your members of Congress directly.

As you’ll see on this G2211 page, the facts bear out our position:

• Primary care office visits are more complex than those conducted by other specialties; Medicare officials agree that updated evaluation and management coding helps but does not fully account for this care. 
• Evidence shows that U.S. adults who regularly see a primary care physician have 33% lower health care costs and 19% lower odds of dying prematurely than those who see only a specialist.
• The typical primary care physician caring for Medicare patients may coordinate care with 229 other physicians working in 117 practices. 
• Every $1 increase in primary care spending yields $13 in savings.
• G2211 does not duplicate other Medicare codes and will not lead to overpayment. No other code accounts for the additional complexity of a primary care office visit.
• G2211 is resource-based and will improve relativity in Medicare payment, particularly given that primary care visits are complex and involve more physician work.
• G2211 is not costly. In fact, it would be paid at just $16.05 in 2024 — when Medicare allots $14.08 for trimming a patient’s nails.
• Access to high-quality primary care inarguably improves health outcomes; G2211 invests in this evidence-based, whole-person, ongoing care.

The AAFP is also calling on Congress to address the true problems with Medicare payment: the program’s outdated, inflation-blind physician fee schedule. We’ve said again and again that Medicare physician payment has failed to keep up with the cost of running a physician practice; it also continues to suffer from an arbitrary budget-neutrality requirement that unnecessarily pits physician specialties against one another. This is the source of the static. Of course other specialties oppose G2211; statute dictates that implementing the code will lessen their own Medicare payment. 

But as the facts above demonstrate, G2211 is not disruptive enough to justify pulling the emergency brake and hurting the majority of Medicare patients, who all deserve robust primary care. G2211 is a substantial investment in primary care, one requiring no upfront federal spending, and it must go into effect as planned next year. It is the best way to stabilize primary care — the country’s largest health care delivery platform — under the nation’s biggest and most influential insurance payer. It is the best way to protect Medicare beneficiaries’ access to essential primary care while overdue systemic change is finally undertaken.

Every clinician knows that Congress must fix budget neutrality and add inflationary updates to the physician fee schedule. Everyone grasps that unnecessary payment reductions are a barrier to care for a growing and aging population. These are the facts, and they require action.

Tochi Iroku-Malize, M.D., M.P.H., M.B.A., is president of the AAFP.