Monitor

HIPAA: Time is on your side

If you didn't meet the Oct. 16 compliance deadline for the Health Insurance Portability and Accountability Act (HIPAA) transactions and code sets standards, you're not alone. After reviewing statistics showing unacceptably low numbers of compliant transactions being submitted, the Centers for Medicare & Medicaid Services (CMS) decided to delay implementation of what it calls "the most sweeping changes ever in the way electronic health care claims are processed." CMS will, for the time being, adopt a contingency plan to accept and process electronic Medicare claims submitted in non-HIPAA-standard formats.

"Implementing this contingency plan moves us toward the dual goals of achieving HIPAA compliance while not disrupting providers' cash flow and operations so that beneficiaries can continue to get the health care services they need," said CMS Administrator Tom Scully.

Physicians and other health care providers shouldn't rest easy, however. Implementation of the transactions and code sets standards will occur, and CMS plans to regularly reassess readiness to determine how long the contingency plan should remain in effect. Physicians and other providers are urged to use this time to complete end-to-end testing, that is, to send HIPAA-compliant electronic claims from their offices to their payers to ensure there aren't any glitches in their system.

Delegates vote for a name change

Last month, the AAFP Congress of Delegates voted to change the name of the specialty from "family practice" to "family medicine," arguing that the new name would help patients and other physicians recognize family physicians as the medical specialists they are.

Also abolished from the family medicine vocabulary was the word "practitioner." Those who specialize in family medicine should be called family physicians, not family practitioners, since practitioners is typically used to refer to nonphysician medical professionals (e.g., nurse practitioners), reasoned the delegates.

The specialty's identity is also being examined as part of the Future of Family Medicine project, due to be completed in the spring of 2004. For an update on the project, see page 43.

Percentage of family physician visits by coding level, 2002

New visits Established visits Level I 3.46 percent - Level II 22.65 percent 11.93 percent Level III 41.65 percent 64.14 percent Level IV 25.26 percent 21.41 percent Level V 6.98 percent 2.52 percent Source: Palmetto GBA. Available at www.palmettogba.com/palmetto/providers.nsf/(docs)/ 85256cf40062c0e98525697000669091?opendocument. Accessed Oct. 23, 2003.

How many colonoscopies does it take to get privileges?

The answer is "as few as five to more than 150," according to a new AAFP study of members with colonoscopy privileges. The study shows that family physicians are receiving privileges based on a wide range of experience. Of those surveyed, 61 percent received hospital privileges after performing fewer than 55 colonoscopies. For more information, visit http://www.aafp.org/x23483.xml.

Waiving the right to sue

To help limit medical malpractice lawsuits, some physicians are asking patients to waive their right to sue by signing "mandatory arbitration" clauses before receiving medical care, according to the Oct. 1 Wall Street Journal. The AMA favors arbitration as a means of settling malpractice allegations, and some states, such as Utah, have passed laws allowing physicians to turn away patients who won't sign arbitration clauses. Supporters say arbitration offers a cheaper, quicker alternative to a trial; critics argue that it leaves patients with no jury and few opportunities to appeal.

Unsatisfactory report card

In its annual State of Health Care Quality report, the National Committee on Quality Assurance (NCQA) estimated that 57,000 Americans die each year due to inadequacies in their health care treatment. NCQA attributes nearly 50,000 of these deaths to known conditions that were not properly monitored, such as high cholesterol and high blood pressure. Americans are not receiving the care they should, says the report, because the health care industry is slow to adopt technology and disseminate information and health care professionals are inconsistent in providing appropriate evidence-based care.

Physician recruitment

Family medicine was the fifth most recruited specialty in 2002-2003 behind radiology, orthopedic surgery, cardiology and anesthesiology, according to Merritt, Hawkins & Associates' 2003 Review of Physician Recruitment Incentives. Recruitment numbers for primary care physicians were down from the previous year - by 10 percent for family medicine and 26 percent for internal medicine. The study also found that the income offered to new family physicians remained about the same, ranging from $120,000 to $190,000, with an average of $146,000.

Copyright © 2003 by the American Academy of Family Physicians.
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