Congressional Testimony Shows Need for Primary Care Investment

AAFP President-elect Steven Furr, M.D., FAAFP, Calls for Legislative Support

Oct. 25, 2023, News Staff — “Primary care in this country is at a tipping point, but Congress can change that,” AAFP President-elect Steven Furr, M.D., FAAFP, told lawmakers during an Oct. 19 hearing on a broad slate of health care topics and related legislation, including Medicare payment.

“Improving payment and reducing administrative burden will not only be an investment in primary care but also in our patients,” he added, summarizing the advocacy goals laid out by the Academy. In detailed written testimony as well as in Furr’s remarks, the AAFP urged Congress to

protect the Medicare G2211 add-on code scheduled to be implemented Jan. 1;
reform the Medicare physician fee schedule’s outmoded budget-neutrality requirements;
enact an annual inflationary update for Medicare physician payments;
support physician practices moving into value-based payment models;
pass the Lower Costs, More Transparency Act, a potential guardrail for health care consolidation;
pass the Improving Seniors’ Timely Access to Care Act;
reform step therapy in Medicare and Medicaid;
require Medicare Part B coverage of all recommended vaccines; and
standardize quality measures across payers and programs.

To amplify this latest congressional testimony, the AAFP has launched a new Speak Out campaign to redouble its G2211 advocacy and support other legislation mentioned during the hearing. The Speak Out tool automatically connects Academy members with their legislators and offers template language.

“Primary care office visits are more complex, and G2211 is intended to recognize that,” Furr told the subcommittee. “Opportunities to meaningfully invest in primary care under our current system are few, but this is one of them. I urge Congress to support implementation of this code.”

Story Highlights

Furr, of Jackson, Ala., was invited to speak before the House Energy and Commerce Health Subcommittee for a hearing titled “What’s the Prognosis?: Examining Medicare Proposals to Improve Patient Access to Care & Minimize Red Tape for Doctors.” The agenda centered on strengthening Medicare payment and ensuring the program’s ability to care for seniors, and included nearly two dozen bills. Besides the AAFP-endorsed Improving Seniors’ Timely Access to Care Act, the Academy’s testimony addressed

the SURS Extension Act, which would extend the Quality Payment Program’s Small Practice, Underserved and Rural Support program, in line with the Academy’s advocacy;
the Fewer Burdens for Better Care Act of 2023, which the AAFP has endorsed and requires the development of a process for collecting stakeholder input on the removal of quality and efficiency measures;
the Saving Access to Laboratory Services Act, which the AAFP has endorsed; and
legislation to extend the incentive payment for participation in advanced alternative payment models, as the Academy has called for.

The Academy’s written testimony also applauded a recently introduced “discussion draft” blueprinting legislation to potentially reform Medicare’s budget neutrality mandate, calling it “an important first step” toward correcting “the zero-sum, budget-neutral nature of the physician fee schedule.”

Complementing this, the AAFP reiterated its staunch support for the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would use the Medicare Economic Index (a measurement of changes in the market price of the inputs used to furnish physician services) to provide an annual inflationary update to Medicare physician payment. Though Congress enacted a temporary 1.25% increase in the conversion factor for 2024, federal statute sets the 2025 update at 0%. In line with the Academy’s advocacy, passage of the bill would help prevent future conversion factor dips and halt a freeze to Medicare physician payment rates now set to last until 2026.

The subcommittee’s agenda also included draft legislation addressing the work geographic index for Medicare physician payment.

“The Academy strongly supports the elimination of all geographic adjustment factors from the Medicare physician fee schedule except for those designed to achieve a specific public policy goal, such as encouraging physicians to practice in underserved areas,” the AAFP said. “At a minimum,” the testimony added, Congress should “extend the physician work GPCI floor of 1.0 to any locality that would otherwise have an index value below that level.” Such a floor would reduce the geographic variations in Medicare payments, a step toward the elimination of geographic modifiers.

The Academy linked inadequate physician payment and spiking administrative complexity to a stagnating supply of primary care clinicians. Data released this week, the Academy said, show that family medicine and internal medicine physicians accounted for more than 16,000 of the 71,309 doctors who left the workforce between 2021 and 2022.

“As a family physician who has cared for patients for more than 35 years, I can speak firsthand to how years of increasingly onerous administrative red tape and Medicare’s repeated cuts to physician payment, while already undervaluing primary care, are fueling our primary care workforce shortage,” Furr testified.

Lines of questioning from the subcommittee members signaled broad understanding of the AAFP’s advocacy and why action is needed.

Following testimony, Rep. Larry Bucshon, M.D., R-Ind., led his questioning by expressing alarm that some 20% of Medicare patients, “when they lose their primary care doctor or their doctor retires, are struggling to find a new physician.”

“You don’t pay doctors enough, they don’t go to rural America and people can’t find their doctor,” he added.

“The physician fee schedule is broken,” said Rep. Raul Ruiz, M.D., D-Calif. “We can’t afford for doctors to close their doors or take fewer Medicare patients because they can’t afford to treat them.” He then explained the importance of tying Medicare payment rates to inflation, as H.R. 2474, which he co-sponsored, would do.

Rep. Nanette Barragán, D-Calif., asked Furr how G2211 would affect patient care.

“What we’re trying to do is take care of our sickest patients, with chronic problems, and make sure we’re able to afford to do that,” he said. Furr then pointed out that the code will benefit specialty care as well, both because specialty clinicians can use it when delivering complex care and because it will reduce the number of patients they see who would be better treated “by primary care physicians up front.”