See What the American Academy of Family Physicians (AAFP) Federal Advocacy Team Has Been Working On.
AAFP Outlines Recommendations to Reduce Health Care Spending
Ahead of a recent hearing, the AAFP wrote to the House Energy and Commerce Committee outlining how investing in primary care can reduce health care spending.
The AAFP recommended Congress take the following steps:
- Support efforts to transition to value-based care to promote and bolster access to comprehensive, continuous, patient-centered primary care. These models provide prospective, population-based payments to support the provision of comprehensive, longitudinal primary care.
- Address the across-the-board cut of 3.37% to Medicare payments that went into effect on January 1, 2024. This cut is undermining positive policy changes intended to promote investment in primary care and hamstringing the Centers for Medicare and Medicaid Services’ (CMS) ability to appropriately pay for all the services a patient needs.
- Address statutory budget-neutrality requirements and the lack of an annual inflationary update to Medicare physician payment, which together continue to hurt physician practices and increase federal health care spending.
- Invest in the country’s graduate medical education system so that it better supports and invests in primary care, including an expansion of training in community-based settings.
- Adopt comprehensive site-neutral payment policies in Medicare, which would save significant money across the health care sector.
- Streamline burdensome prior authorization requirements by reintroducing and passing the Improving Seniors’ Timely Access to Care Act, which would codify implementation of an electric prior authorization program in Medicare Advantage and require plans to provide real-time decisions—averting care delays and increased costs.
- Pass legislation to require Medicare Part B coverage of all recommended vaccines, allowing beneficiaries to access vaccines more readily from their usual source of care and improving our nation’s uptake of one of the most cost-effective public health measures.
Final Rule Released for the Treatment of Opioid Use Disorder
The Substance Abuse and Mental Health Services Administration released the final rule on medications for the treatment of opioid use disorder, which makes certain COVID-19-era flexibilities permanent for opioid treatment programs, including allowing take-home doses of methadone, prescribing medications for opioid use disorder via telehealth without an initial in-person physical evaluation and revising stigmatizing language.
WHAT WE’RE WORKING ON:
- The AAFP commented on the proposed rule and expressed appreciation that the final rule allows for greater clinical autonomy and shared decision-making between the patient and clinician.
- The AAFP continues to advocate for long-term behavioral health care improvements, such as more resources to integrate behavioral health care into accessible primary care settings, improve crisis responses and enhance stabilization care.
AAFP Works to Ensure Family Physicians Experience the Full Benefits of G2211
Family physicians expressed appreciation of the implementation of the G2211 Medicare add-on code that began on January 1, 2024. However, we have work ahead of us to ensure that family physicians experience the full benefits of this code as intended—specifically, allowing payment for G2211 when an office or outpatient evaluation and management (E/M) visit is reported with modifier 25.
When a separate E/M service is performed in a visit, modifier 25 is attached to the coding of the visit. For example, addressing a complaint of sinus congestion during an annual wellness visit would be a separate, distinct E/M service. Unfortunately, G2211 is not payable when the accompanying E/M visit is reported with payment modifier 25. This means that when a physician provides comprehensive care and services to address all of a patient’s needs in a single visit, they are unable to receive the additional resources G2211 offers for the additional complexity and time it takes to be the patient’s ongoing focal point of care.
WHAT WE’RE WORKING ON:
- The AAFP urged CMS to allow payment for G2211 when billed alongside an E/M visit in the 2025 Medicare physician fee schedule when modifier 25 is attached (or, at minimum, when modifier 25 is used to bill an E/M visit alongside a Medicare annual wellness visit).
- We’ve also joined a letter with the American College of Physicians and American Academy of Home Care Medicine in support of G2211 resources being available for E/M visits provided in home and residence settings.
AAFP Endorses Reauthorization of Legislation to Promote Physician Well-being
Research shows that physicians in the U.S. suffer a higher suicide rate than almost any other profession. The AAFP endorses reauthorization of the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, which has already begun to address the mental health needs of our nation’s health care workers by investing in programs to protect their mental health and end the stigma medical professionals often face when seeking necessary treatment and support. This legislation would reauthorize those programs through 2029, which otherwise expire at the end of this year.
WHAT WE’RE WORKING ON: The AAFP joined a coalition letter with other health care groups in support of the Lorna Breen Act. The original Lorna Breen legislation established grants and required other activities to improve mental and behavioral health among health care providers.
For the latest policy updates impacting family medicine, follow AAFP Advocacy at @aafp_advocacy.
Post author: American Academy of Family Physicians (AAFP)
