Primary care plays a vital role in the U.S. healthcare system, helping keep patients healthier while preventing and managing chronic conditions. Yet, reimbursement to support them has historically fallen short, leaving primary care under-resourced and struggling to provide patients with complex conditions the care they need and deserve.
According to the Centers for Disease Control and Prevention, over half of all adults in the United States have at least one chronic condition, and two in five have two or more. These conditions can be costly and time-consuming to manage, and they can put a significant burden on patients and their families.
As a practicing family medicine physician, I personally know the challenges of caring for patients with complex health conditions without the valuable resources needed to meaningfully address their illness. As a nation, we chronically underinvest in primary care, and this is a tangible threat to public health. We have the opportunity to make change happen, now.
That’s why we are calling on congressional leaders to pass legislation implementing code G2211 in the 2024 Medicare Physician Fee Schedule, and invite you to join us by reaching out and adding your voice before September 11.
What is it and why does it matter?
Code G2211 is an add-on payment intended to recognize the inherent costs clinicians may incur when longitudinally treating a patient's single, serious, or complex chronic condition. The code is important because it will help to ensure that primary care physicians are adequately compensated for the time and effort they put into providing comprehensive care for patients with complex needs. This is especially important given the increasing prevalence of chronic conditions in the United States and the shortage of primary care physicians to treat them.
According to the proposed fee schedule, code G2211 would be used for evaluation and
management visits that meet the following criteria:
The visit is for a patient with a single, serious condition or a complex condition.
The visit requires more than 20 minutes of face-to-face time with the physician.
The visit requires the physician to perform additional services, such as ordering tests or providing counseling.
In my experience, the majority of primary care encounters meet at least one of these criteria, indicating an important opportunity to improve primary care compensation in the very near future.
Join the wave of support for primary care
Elation joins the American Academy of Family Physicians, The American College of Physicians, the Primary Care Collaborative, Primary Care For America, and many others in supporting code G2211. Primary care is essential for our health and well-being, promoting preventive care, managing complex conditions, and coordinating care—all of which require the management of more data, tasks, and collaborators per patient than any other medical discipline. We both support this high level of care and stand on behalf of the physicians delivering this care. The time, effort, and resources required of primary care to treat complex patients must be recognized and compensated commensurate with the value of care being delivered.
Code G2211 is due to go into effect in 2024, but there are efforts underway by 19 surgical specialties to interfere with its implementation, asserting that it would penalize surgeons and overpay primary care. This ignores the evidence that primary care is the only discipline in medicine which decreases population mortality rates, improves life expectancy, and reduces healthcare expenditures.
While the need for further reforms to the flawed fee-for-service payment system remains, the implementation of this code is a welcome and vital step toward recognizing the importance of primary care in the management of complex chronic care. It would improve access to care, promote the coordination of care, and help reduce the costs of care for these patients. It would be a significant victory for patients, primary care, and the healthcare system.
Read Elation’s letter to Congress here, and we encourage you to write to our leaders before the September 11, 2023 deadline to ask for support for G2211 in the 2024 Medicare Physician Fee Schedule to ensure that all patients have access to high-quality primary care.