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To the editor:
I read the article in the July FP Report on maintenance of certification. The new rules look more and more like the Joint Commission on Accreditation of Healthcare Organizations "rules." Most if not all physicians believe JCAHO is a hindrance to patient care. Now our own Academy is about to go down the wrong road with the best of intentions. I predict the same results that JCAHO has achieved. Lots of additional paperwork. Lots of changes. Patient care loses. The paperwork involved will grow exponentially, as with the Health Insurance Portability and Accountability Act. Patient care will suffer because of the increased effort to keep up with the added paperwork. Doctors' income will suffer. There is no foreseeable benefit, only harm. Although I believe change is needed to assure quality care, I doubt this approach will benefit anyone other than the new group of "consultants" that will come out of the woodwork to offer their help to meet recertification requirements. The idea is good. This approach is wrong.
Scott Johnston, M.D.
Wright, Wyo.
To the editor:
| To the reader Write us a letter of 200 words or fewer (subject to editing). FP Report, 11400 Tomahawk Creek Parkway, Leawood, KS 66211-2672; fax them to (913) 906-6089; call (800) 274-2237, Ext. 5230; or contact fpreport@aafp.org via e-mail. |
This letter responds to Dr. Johnston's letter expressing concerns about the American Board of Family Practice's new Maintenance of Certification Program for Family Physicians, or MC-FP. The ABFP is very sensitive to the issues he has raised and has attempted to address them in planning for the introduction of MC-FP in January.
First, let me clarify that the maintenance of certification process is a mandatory initiative of the American Board of Medical Specialties, an organization of 24 medical specialty boards, including the ABFP. This new process responds to national concerns about the quality of the American health care system.
Each board was required to submit its plans for a specialty-specific maintenance of certification process to the ABMS by July 1, 2003, with implementation to follow shortly thereafter. The ABFP has designed MC-FP so that it will take no more time than the current recertification process. The only difference is that Diplomates will be asked to participate in selected components on a regular basis (namely, the Self-Assessment Modules in Part II). It is important to note that the actual amount of time spent completing these modules, as well as the Performance in Practice Modules in Part IV, will be credited toward the 300-hour CME requirement. Diplomates will be able to complete these modules from their home or office computer, thus offsetting some of the cost and time they would have incurred obtaining CME.
The ABFP believes that the cost of participating in MC-FP will be less than that associated with the current recertification process. The cost of accessing MC-FP via the Web should be offset by the savings realized by CME offsets for completing parts II and IV, and by avoiding travel, hotel costs and lost income from practice now associated with taking the recertification exam at a limited number of written test centers on a single day (by 2005, the exam will be offered by computer at more than 200 sites and on multiple dates).
MC-FP is designed to be a value-added activity for physicians. In the future, reimbursement will be tied to quality. The ABFP expects participation in MC-FP to satisfy these requirements, as well as those being discussed by several state licensure boards.
MC-FP will help board-certified family physicians provide even better care to their patients by continuously measuring their ongoing competencies in medical knowledge, patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice. As a result, the process will help assure the American public that every ABFP Diplomate has met the highest standards of accountability.
James Puffer, M.D.
Executive Director
American Board of Family Practice
To the editor:
I wish to add my support to the letter "Midlevel Providers Undermine Specialty of Family Practice" in the July FP Report.
Medicare's fees are a third of what my "fee-for-service" patients pay. Insurance companies have offered contracts at 80 percent of Medicare allowable rates. They can do this because there is an "oversupply" of primary care providers. Insurance companies do not care whether patients receive care from family physicians or by less-qualified nurse practitioners or physician assistants.
To borrow from Jonathan Swift, I wish to make a modest proposal. We should reduce the number of family medicine residency positions by up to 50 percent. This will eliminate our "fill rate" problems. Following supply-demand economics, our value will increase.
This strategy only works if we also address the midlevel provider problem. We should resist all attempts by them to practice independently. They are not qualified to see patients without supervision. We should also discontinue employing midlevel providers in our office.
Initially, practice income will decrease from the loss of "passive income" from midlevel providers. The loss of residency slots will further shift the percentage of primary care to specialist physicians. But there is a payoff: We will gain respect from our patients by becoming their "physician," as opposed to their "primary care provider." Having fewer providers of primary care services will increase our demand and our negotiating power, allowing us to receive fair compensation for our time.
Kenneth Woliner, M.D.
Boca Raton, Fla.
To the editor:
I read with great interest the August FP Report story "HIPAA Transactions Standards: Ready or Not, Here They Come."
Let me share my experience. According to my office manager, we've been through the first of three computer software upgrades to deal with changes to implement the Health Insurance Portability and Accountability Act.
During this first upgrade, changes were made from our end and from our clearinghouse (which then sends out claims to each individual insurance company). We had claims rejected because of problems on both ends and had to refile some of those rejected claims three times before the software problems were corrected.
Our cash flow during this time was down about 15 percent, and the lag time to get that money back in our system was three to six months.
I have taken out a $50,000 line of credit that I can tap into at any time. Fortunately, I haven't had to do that yet, but I have told my wife and family that I don't feel we should plan any big vacations or buy any big-ticket items until we are all the way through this transition.
Ed Bujold, M.D.
Granite Falls, N.C.
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