Fighting for that $16.04
You just have to love government healthcare. In 2021, Medicare tried to boost the pay for primary care doctors a little bit by trying to reward cognitive care. You know, spending more time with a patient and going over their issues as opposed to just doing procedures for big bucks.
The G2211 code was first introduced in 2021 as part of Medicare’s Physician Fee Schedule for physicians, its text indicating that it was meant to boost compensation for providers “serving as the continuing focal point for all of the patient’s healthcare services needs” or providing “ongoing medical care related to a patient’s single, serious…or complex condition (eg, sickle cell disease).”
All this for an extra $16.04.
The analysis of Medicare claims data found that in 2024, its first year of use, the G22111 code was billed 26 million times for 10.6 million patients, generating about $394 million in payments.
But specialists billed more G22111 codes than primary care physicians, the study found.
I don’t know why this makes me laugh. Maybe because even when the system wants to some how reward primary care doctors, others jump right in for their piece of the pie.
First author Ishani Ganguli, MD, MPH, a primary care physician at Mass General Brigham and health services researcher at Harvard Medical School, Boston, said she was disappointed but not surprised that specialists most frequently used a code that was developed to help primary care.
“It was really meant to try to provide an additional payment for doctors providing longitudinal care and holistic care,” Ganguli said.
Speaking of “hole” istic care, I had a colonoscopy not long ago. I wrote about this in my newsletter at that time:
The nurse checking me in asked me the same medical questions I had answered multiple times in the process of getting this procedure scheduled. Her last question was different, however.
“Do I feel safe at home?”
I responded, “That is weird to ask me while I have prepped for 12 hours, I’m naked, and sleep deprived. Is that a quality metric they make you ask patients?”
The nurse, instead of explaining anything, just got mad at me and said they screen people all the time. I told her that sounds like it should be done at their family doctor’s office, and she scolded me, saying that patients aren’t always alone in those visits. I really didn’t want to argue this point. I was pretty vulnerable with my junk all out on the gurney. I just said “ok” and “no,” and I was safe. She played it off with a fake niceness as she put my IV in, etc., but then as she left, I saw her half-smile turn into a scowl. I could tell she hated me. Then it hit me. It’s obvious she has had some trauma in her life, and this issue was really important to her. It was still weird, but at least we did find one person positive with this screen – the nurse asking the question. I was so puzzled by all this. Why would this question be asked right before they wheel your naked ass into the colonoscopy suite? I don’t want to make light of the question about abuse, but I guarantee it was some third-party imposed metric. For the nurse, however, I wish her the best, and I hope she gets some peace in her life. I don’t know if she forgave me or not, but I did notice that when I got back to the room after the procedure, there was a different nurse.
So, were all those medical questions part of the longitudinal care needed to bill the G22111 code? Was the “Are you safe?” question really about me or the $16.04?
I don’t know the answer to all this, but the fact that the specialists were able to game the system so quickly for the few crumbs aimed at primary care tells me once again that Direct Primary Care is the answer to all this.
Can we just stop trying to fight for scraps at the government trough and start being our own boss?
That made me laugh at the same time you probably did. Of course the specialists were like “Oh yeah, we could bill for that, too.” And you’re right about the “feeling safe at home question.” It’s not about you; it’s about hitting that metric.
Mark my words! If the specialty doc (GI) sees the patient reports abuse, they’ll dump them right back down to the primary care doc. Will likely pray the patient has one so they can toss the “chit downhill” and not have to mess with it! Another thing. If the stupid “gubbermint” makes docs ask that question and they get paid for it, whaddya’ think they’re gonna do?
Ask the stupid question for more money or fake it and get paid extra every time!!! Even if they’re with longstanding patients who have great family support with no abuse evident. Am retired but I’d tell the patient I have to ask this anyways but I’m not suspicious. Get paid an easy extra $16.04? I’d take it. Shoot I likely took care of the whole family and already saw they had healthy social interactions with each other and didn’t take advantage or abuse their elder members.
Oh another thing. Most abused patients will say, “No” to the question as they DO NOT want to face retaliation from the abuser(s) if they found out they reported them. I reported suspected abuse several times in my career. The authorities down here were very professional. On two occasions the families were at their wit’s end dealing with an elder and the investigators got the families help. The investigators later visited me and told me the outcome of the case and they got the patient the appropriate help. A report would be sent shortly. The investigators were sympathetic as they realized that many of the abused won’t report it to practitioners even if asked for fear of reprisals.