Tochi Iroku-Malize is the president of the American Academy of Family Physicians, which represents nearly 130,000 physicians, residents and medical students nationwide. Omar T. Atiq is the president of the American College of Physicians, representing internal medicine physicians, related subspecialists and medical students.
Picture this: A patient visits their primary care doctor for a bad cough. Their physician will examine vitals, ask questions about the cough, help the patient come up with a care plan and perhaps refer the patient for a chest x-ray. During this appointment, the primary care physician will ask about family life, health goals and even screen for depression. They will work closely with the patient to ensure they are adhering to medications, make certain they are up to date on cancer screenings and vaccinations and may even refer patients to a dentist or recommend an eye exam.
That’s to say, primary care visits are thoughtful, complex and all about ensuring patients’ comprehensive healthcare needs are being met.
Here's the catch, though: Current billing codes and regulations prevent physicians from being appropriately compensated for these varied, complex services.
The equation is simple and proven: Better access to primary care equals better patient health outcomes. The evidence shows U.S. adults who regularly see a primary care physician have 33% lower healthcare costs and 19% lower odds of dying prematurely than those who see only a specialist. And every $1 increase in primary care spending produces $13 in savings.
The reality is that improving primary care access keeps people out of the hospital and reduces mortality rates, all while lowering healthcare spending.
The problem is our system is set up to provide sick care, not healthcare. Decades of underinvestment have resulted in a system with too few primary care physicians, shorter patient visits and long appointment wait times.
However, the tide is beginning to turn. One physician billing code — set to go into full effect next year — is designed to compensate for the complex, high-value visits primary care physicians provide as part of a longitudinal relationship with a patient.
Medicare pays for physician services based on the cost of providing those services — everything from the physician’s time to the crunchy paper you sit atop on the exam table. The physician billing code known as G2211 allows physicians to capture the full scope of their visits with their patients. It is a direct investment in the evidence-based, whole-person primary care that patients need. It pays for all the added work and resources required to provide ongoing, holistic care, such as modifying medication doses, providing referrals to and coordinating with several specialists, administering vaccines, providing preventive screenings and counseling on sleeping, eating and exercising.
G2211 fits squarely into the above equation — by more appropriately valuing and paying for primary care, it ensures better patient access and leads to better patient health outcomes. It’s a step toward rectifying the compensation disparities that have contributed to a glaring workforce shortage, with an estimated up to 48,000 primary care physicians needed by 2034. Most importantly, it allows practices to keep their doors open so they can continue to provide the high-quality, affordable care patients need.
However, this long overdue payment correction for primary care is at risk.
Rather than delaying or denying the implementation of G2211, it is critical that Congress address the root cause of the problem: an outdated Medicare physician payment system. Law requires that Medicare spending on physician services remain flat year over year, without any built-in adjustment to account for inflation. As a result, Medicare physician payments have failed to keep up with the cost of running a physician practice. The current payment system also includes an arbitrary budget neutrality requirement that unnecessarily pits physician specialties against one another — thus leading to some specialties opposing the implementation of G2211 due to it having a negative impact on their payments.
The requirement for budget neutrality also hamstrings CMS’ ability to ensure physicians are paid appropriately for all the services patients need and undermines needed investments in primary care. This is why primary care physicians are calling on Congress to ensure G2211 goes into effect as planned in 2024. This approach ensures some stability and more appropriate payment for primary care payment while we work to address these larger issues.
Fixing a flawed Medicare payment system cannot come at the expense of primary care. The call to action has never been clearer: Do not delay G2211. Congress must address the broader issues of budget neutrality and the lack of inflationary updates in the physician fee schedule to stop unnecessary payment reductions and enable Medicare to meet the needs of a growing and aging population. The bottom line is that G2211 is not just about ensuring physicians are adequately paid. It is about protecting patients’ access to the comprehensive, longitudinal, high-value primary care they need.