• New Pandemic Stimulus Brings Wins, Concerns for AAFP

    Academy Analysis Outlines Bill’s Impacts on Family Physicians

    December 23, 2020, 1:55 pm News Staff — A long-stalled fourth round of COVID-19 emergency relief that Congress passed on Dec. 21 delivered mixed news for primary care practices set to start 2021 with the largest Medicare reimbursement increase in decades.

    Capitol building in winter

    After months of deadlock, Congress agreed to bundle some $900 billion in pandemic assistance into the 5,600-page 2021 appropriations bill that funds the federal government. Significant elements of that omnibus legislation affect primary care and reflect the Academy’s staunch advocacy, particularly its support for an evaluation and management payment boost that drew strong opposition from other medical specialties.

    The result is a compromise that favors AAFP members: Payment for most office-based E/M services will increase as planned on Jan. 1; however, the bill directs CMS not to implement a planned add-on code acknowledging the unique complexity of primary care E/M visits (proposed as GPC1X and renamed G2211 in the Medicare physician fee schedule final rule) until 2024.

    “While the AAFP applauds the passage of this legislation and recognizes the tremendous positive impact it will have on individuals, families and the country as a whole, we are disappointed that, in the closing hours of negotiations, some members of Congress successfully secured provisions that will further decrease funding to our already underfunded primary care infrastructure,” AAFP President Ada Stewart, M.D., of Columbia, S.C., said in a statement. “The AAFP is dismayed by any action that would deliberately remove primary care financing provisions that stood to improve the health of millions of people.”

    Elsewhere, the bill contains a meaningful win for the Academy following years of sustained lobbying, including an extension of mandatory funding for community health centers, the National Health Service Corps and the Teaching Health Center Graduate Medical Education program at current levels through fiscal year 2023.


    The Academy has issued an analysis of the bill, including its pandemic-relief features. It identifies a number of provisional victories for primary care, as well as other policy updates.


    The bill appropriates $3 billion to mitigate the substantial negative impact of budget neutrality requirements on the Medicare physician fee schedule. The AAFP’s summary notes that this should “positively impact family physicians’ Medicare rates in 2021.”

    Halting implementation of the G2211 add-on code until 2024 “will likely reduce the volume of Medicare payment increases for office visits in 2021,” the summary says, but it also will result in a higher Medicare conversion factor (the number multiplied by the relative value of each code in the fee schedule to determine the Medicare payment rate).

    Among other Medicare changes, the bill also

    • temporarily freezes Advanced Alternative Payment Models bonus thresholds at current payment levels and patient counts, allowing participants to receive 5% bonuses for performance years 2021 and 2022;
    • delays forthcoming Medicare sequester payment reductions through March 31;
    • adjusts the Medicare Geographic Index Floor to increase payments through 2023 for the work component of physician fees in areas where labor cost is lower than the national average; and
    • implements a comprehensive rural health clinic payment reform plan, raising the statutory RHC cap to $100 on April 1 and gradually increasing it each year through 2028, when the cap will reach $190.


    Among other measures related to testing, contact tracing and vaccination, the bill provides $8.75 billion through the CDC to help federal, state, local and tribal public health agencies distribute, administrate, monitor and track COVID-19 vaccination.

    Paycheck Protection Program

    The bill clarifies that deductions are allowed for expenses paid with proceeds of a forgiven PPP loan, effective as of the date of enactment of the Coronavirus Aid, Relief and Economic Security Act and applicable to subsequent PPP loans.

    The bill also

    • institutes a second PPP forgivable loan of up to $2 million for the hardest-hit small businesses and nonprofits with 300 or fewer employees;
    • makes personal protective equipment an eligible and forgivable expense; and
    • extends the covered period for Emergency Economic Injury Disaster Loan grants through Dec. 31, 2021.


    The bill provides for the distribution of 1,000 additional Medicare-funded graduate medical education residency positions. Rural hospitals, hospitals that are already above the Medicare cap for residency positions, hospitals in states with new medical schools, and hospitals that serve Health Professional Shortage Areas will be eligible for these new positions.

    It also extends until Sept. 30, 2021, the Conrad 30 J-1 visa waiver program for physicians working in underserved areas. The Academy pressed for an extension of this program in May.

    Surprise Billing

    Health plans will be required to hold patients harmless from surprise medical bills, and the legislation establishes a 30-day open negotiation period to settle out-of-network claims. The Academy is among numerous medical groups that have long called for reform in this area.