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Friday Oct 06, 2017

Patients and physicians agree: not enough time for care

If you don’t feel you’re spending enough time with your patients during appointments to provide the best care, it’s likely your patients agree with you.


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Posted at 05:00PM Oct 06, 2017 by David Twiddy | Comments [0]

Thursday Aug 17, 2017

Are you ready to provide FAA BasicMed exams to pilots?

As of May 1, Congress changed the rules for how the pilots of small private planes may choose to receive medical clearance to fly. Instead of undergoing the full FAA-sanctioned physician exam, certain pilots can get certified by their personal physician.


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Posted at 04:14PM Aug 17, 2017 by Barbara Hays | Comments [0]

Friday Jun 02, 2017

CMS renames and expands locum tenens arrangements

The Centers for Medicare & Medicaid Services (CMS) is changing how it describes locum tenens arrangements. Effective June 13, CMS will use the term “fee-for-time compensation arrangements.”


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Posted at 03:14PM Jun 02, 2017 by Kent Moore | Comments [0]

Tuesday Mar 28, 2017

HHS warns of spoofing scam involving its fraud hotline

The U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) is warning that its fraud hotline telephone number is itself being used as part of a telephone spoofing scam. These scammers represent themselves as HHS OIG employees, even tricking caller ID to make it seem as if the call is coming from the HHS OIG Hotline, 1-800-HHS-TIPS (1-800-447-8477). They then try to obtain or verify the victim’s personal information, which can then be used to steal money or commit other fraud. HHS OIG is investigating and trying to shut the scam down.

In the meantime, HHS OIG stresses that it does not make outgoing phone calls using the HHS OIG Hotline telephone number, and that you should not answer calls from 1-800-447-8477. It is still safe to call into the HHS OIG Hotline to report suspected fraud and abuse. You can also use the HHS OIG Hotline to report if you believe you may have been a victim of the spoofing scam. Alternatively, you can email your information to spoof@oig.hhs.gov or file a complaint with the Federal Trade Commission at 1-877-FTC-HELP (1-877-382-4357).

More information is available on the OIG Consumer Alerts webpage(oig.hhs.gov).

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians


Posted at 09:56AM Mar 28, 2017 by David Twiddy | Comments [0]

Thursday Feb 16, 2017

Executive orders and family medicine

Amid the furor surrounding other executive orders recently signed by President Donald Trump, family physicians may find one on which they can agree.

On Jan. 30, the administration issued an executive order titled, “Reducing Regulation and Controlling Regulatory Costs.”(www.whitehouse.gov) The order establishes a framework designed to reduce the cost of compliance with federal regulations. First, it provides that federal agencies, when proposing a new regulation, must “identify at least two existing regulations to be repealed.” Second, it requires that the incremental cost of any new regulation be “no greater than zero.”

The stated intention of the executive order is to decrease the cost of running a business (such as a family medicine practice), to the extent that regulations from federal agencies contribute to such costs.  The order says that all new regulations must be cost-neutral and that the net impact (new regulation minus the two repealed regulations) cannot increase "incremental costs" on the regulated community. Finally, exceptions will be considered on a case-by-case basis. 

The implementation of the order is left to the Office of Management and Budget (OMB). On Feb. 2, OMB issued to all government agencies a memo containing interim guidance and frequently asked questions(www.whitehouse.gov) on how to implement this order.  This memo clarifies that:

•    The order applies to "significant" regulations. "Significant" is not defined in the guidance, but under a 1993 Executive Order still in effect, a "significant" rule is defined as any that imposes an annual economic cost of $100 million or more.  
•    Government agencies intending to issue a “significant regulatory action” on or before Sep. 30, must first “identify two existing regulatory actions the agency plans to eliminate or propose for elimination” before the new regulation is issued.
•    Agencies must “fully offset total incremental cost” of the new regulation as of Sep. 30.
•    The costs of regulations are “measured as the opportunity cost to society,” defined as "the net benefit [a] resource would have provided in the absence of the requirement."
•    Waivers exist for regulations that address health, safety or financial emergencies. 

Future rules governing Medicare physician payment (such as those implementing the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA) could be shaped by this order. Stay tuned!

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians


Posted at 09:59AM Feb 16, 2017 by David Twiddy | Comments [0]

Friday Dec 02, 2016

University of Colorado clinic wins 2016 FPM Award for Practice Improvement

The University of Colorado School of Medicine Department of Family Medicine has won this year’s Family Practice Management (FPM) Award for Practice Improvement. The department was presented with the award Friday during the Society of Teachers of Family Medicine Conference on Practice Improvement being held in Newport Beach, Calif.

FPM Editorial Advisory Board member John Bachman, MD, presented the award to the department’s medical director, Corey Lyon, DO.

The program was recognized for its success in implementing a team-based model to address access issues, poor outcomes, and burnout. Implementation included increasing provider support with additional medical assistants and support staff, and expanding their roles.

“Culture will eat strategy for breakfast, lunch, dinner, and a midnight snack,” Lyon said. “We had to move beyond the culture of ‘I can’t do that. That’s not how we do it.’”

After one year, monthly visits increased 25.6 percent. Staff costs per visit were unchanged, but monthly charges increased 20 percent. Additionally, provider self-reported burnout was reduced by half.


Posted at 05:17PM Dec 02, 2016 by David Twiddy | Comments [0]

Tuesday Sep 27, 2016

Survey shows troublesome practice environment could affect patient access

Negative opinions about the state of medicine has large numbers of physicians planning to change their practices in ways that would decrease access to patients, according to a new study by The Physicians Foundation and Merritt Hawkins(www.physiciansfoundation.org).

Almost half of the more than 17,000 physicians surveyed this spring said they planned over the next one to three years to cut back on hours worked, retire, take a non-clinical health care position, switch to a cash-only practice, or take other steps that would ultimate reduce access to patients.

"(The survey) reveals a physician workforce that continues to be dispirited about the current state of the medical profession and apprehensive about its future, due primarily to the large regulatory burden physicians face and the perceived erosion of their clinical autonomy," the researchers said in the report.

Overall, only 52 percent of physicians said they planned to remain working at the same level they are now. That represents a decline from 2014 when 56 percent of physicians surveyed said they didn't plan to change their practice.

The reasons for the negative changes are widespread. Almost 63 percent of respondents said they felt either "very" or "somewhat" pessimistic about the future of medicine, which was an increase from 51.1 percent in 2014. Eighty-one percent of physicians said they were overextended or at full capacity and unable to see more patients.

That said, many physicians aren't ready to abandon medicine entirely. Almost 72 percent of respondents said they would choose medicine as a career again, compared with 71 percent in 2014 and 67 percent in 2012. When asked if they would still recommend medicine as a career to their children or other young people, 51 percent said they would, up slightly from 50 percent in 2014.

Primary care physicians were a little more optimistic than their specialist peers, with 50.5 percent saying they are very or somewhat positive about the current state of medicine and 42.5 percent positive about the future of medicine. By comparison, 43.5 percent of specialists were positive about the present and 33.9 percent were positive about the future of medicine. Almost 73 percent of primary care physicians said they would choose medicine again as a career, compared with 71.4 percent of specialists, and 54 percent of primary care physicians said they would recommend medicine as a career to young people, compared with 50 percent of specialists.

The demographics of those responding to the survey showed the continuing trend of physicians leaving private practice for employed positions. Almost 33 percent characterized themselves as practice owners while about 58 percent said they worked for a hospital or large medical group. By comparison, 35 percent identified as practice owners in 2014 and 53 percent worked for large health groups and hospitals.

Looking at specific pieces of health care reform, only 43 percent said they were paid based on quality or value and 80 percent professed little knowledge of the Medicare Access and CHIP Reauthorization Act (MACRA). Only 11 percent of respondents said electronic health records have improve their interactions with patients, and only between 5 percent and 6 percent said the year-old ICD-10 coding has improved efficiency and revenues.


Posted at 11:10AM Sep 27, 2016 by David Twiddy | Comments [0]

Monday Feb 22, 2016

New insurer database tool could cut back on phone calls to physicians

The Council for Affordable Quality Healthcare (CAQH) has created a centralized way for physicians to update their information in insurance plan directories and reduce the amount of time they spend talking to insurance companies.

The nonprofit alliance of insurers and health care providers has created DirectAssure(www.caqh.org), a database that coordinates with CAQH’s current ProView tool used by more than 800 health plans for such things as credentialing.

CAQH said it will contact physicians designated by participating health plans at least once a quarter to ask them to review and update their information. Physicians can then log on to the system for free and update their location, contact information, specialty, and group/institution affiliation, as well as whether they’re accepting new patients.

CAQH said the health plans can check the DirectAssure system to make sure their directories are correct, instead of a physician receiving several calls from the plans themselves.

Besides making things easier for physicians, the new system is aimed at meeting new federal and state requirements that health plans do a better job of keeping their provider databases current and accurate and more useful to patients.


Posted at 01:44PM Feb 22, 2016 by David Twiddy | Comments [0]

Thursday Jan 14, 2016

Surveyed physicans say burnout is increasing

A new study indicates the ongoing focus on physician burnout is not unwarranted. The number of physicians unhappy in their practices is on the upswing.

Medscape’s Lifestyle Report 2016(www.staging.medscape.com) found that the burnout rate for physicians in 25 specialties surveyed went up from past studies. Fifty percent or more of respondents from a dozen specialties reported a lack of personal accomplishment, cynicism about their work, and a general lack of joy coming into the office.

Among those were family physicians, 54 percent of whom said they were burned out.

On a scale of one to seven, with seven being the worst, family physicians rated their feelings of burnout at 4.37. This was the seventh-highest severity rating, tied with cardiologists. Critical care physicians reported a slightly higher rating at 4.74. Psychiatrists reported the lowest rating at 3.85.

Female physicians again reported a higher prevalence of burnout (55 percent) than their male counterparts (46 percent), although both genders have seen a steady increase since 2013 (45 percent and 37 percent, respectively).

Respondents identified increased bureaucratic tasks as the leading cause of their burnout, although working too many hours, increasing use of computers, and inadequate income also scored highly.

The survey, which polled almost 16,000 physicians, also asked about potential biases toward specific groups of patients and how likely those biases affected the treatment they provided. It found that overall 40 percent of physicians reported some level of bias, with family physicians reporting the fourth-highest level at 47 percent. The highest was among emergency medicine physicians (62 percent), while the lowest was among pathologists (10 percent), a specialty that rarely deals with patients directly.

In terms of whether bias affected patient treatment, 11 percent of family physicians said it did, the same rate as orthopedists, psychiatrists, and rheumatologists. The highest rates were 14 percent of emergency medicine physicians and 12 percent of plastic surgeons. The survey noted that of those who reported that their biases affected how they treated their patients, 29 percent said the effect was negative, 25 percent said it was positive (e.g., overcompensation and special treatment), and 24 percent said it was a mix of the two.

The survey also suggested there may be a relationship between burnout, which can cause depersonalization, and bias. Forty-three percent of physicians who reported burnout also reported bias, whereas 36 percent of physicians who did not report burnout reported bias.


Posted at 10:41AM Jan 14, 2016 by David Twiddy | Comments [0]

Monday Jan 05, 2015

Five issues to watch in 2015

Family physicians spent much of 2014 wrestling with the seismic changes affecting medicine across the United States and in their practices. That won’t slow down in 2015. “The coming year will again be one of major transition for the U.S. healthcare system,” said Lou Goodman, PhD, president of The Physicians Foundation and chief executive officer of the Texas Medical Association, in a statement announcing the Foundation’s “Physician Watch List for 2013.” The list, based on the Foundation’s own research, policy papers, and physician surveys, identifies the five issues most likely to affect physicians and their patients this year.

1. Accelerating consolidation. Hospitals and health systems are buying up small practices and absorbing solo physicians at a faster pace. Besides affecting local competition, costs, and patient choice, the trend has physicians worried about clinical autonomy. The Foundation’s 2014 Biennial Physician Survey(www.physiciansfoundation.org) found that 69 percent of those participating said they had concerns about autonomy and being able to make the best decisions for their patients. It said that as the consolidation isn’t expected to slow down, hospitals and physicians must work together to prevent bureaucracy or other organizational factors from influencing medical decision-making.

2. The physician-patient relationship is stressed. The increased documentation of value-based reimbursement systems and perceived interference of health care employers are considered key external pressures on the relationship between patients and their physicians. In particular, physicians have told the Foundation that these factors are eating into their face-to-face interactions with patients while also limiting their choices of practice types and requiring more time spent negotiating with payers and vendors. These pressures will call for more reliance on practice support staff to help the physician retain as much focus on the patients as possible.

3. ICD-10 finally arrives. Physicians were given a one-year reprieve when the Centers for Medicare & Medicaid Services (CMS) postponed the implementation date for the new ICD-10 coding structure to Oct. 1, 2015. But the extra time likely won’t improve many physicians’ outlook or support. According to the Foundation’s survey, half of respondents expected ICD-10 to cause severe administrative problems in their practices and three-quarters said it will unnecessarily complicate coding. Still, it’s highly unlikely CMS will delay ICD-10 again, so practices need to make the necessary investment of time and money to be ready for the change.

4. Patients demanding the true cost of care. Medical costs were once a hidden algebra to the public, deciphered only by payers and health care administrators. But media focus in recent years(time.com) on the lack of transparency in billing practices, as well as higher out-of-pocket costs for patients, has the public much more frustrated. The seeming arbitrariness of what certain procedures actually cost stands to make it harder for physicians to make the best clinical decisions and calls for policymakers, providers, and payers to build a more straightforward cost of care structure.

5. Patient access to care. As more people are gaining access to health insurance through the Affordable Care Act and demanding health care services, the overall number of physicians is declining or reducing the amount of time available to see patients. According to the Foundation, 44 percent of respondents in its survey said they were planning to reduce access to their services, such as shrinking their panels, retiring, going to part-time work, or taking non-clinical jobs. This could reduce patient access to care by tens of thousands of full-time equivalents (FTEs) in the future. The Foundation, along with the University of North Carolina-Chapel Hill, has developed a tool(www.physiciansfoundation.org) to help analysts and lawmakers to better gauge future shortages of physicians.

Goodman said the list shows the continued threat to small medical practices and that policymakers must “bring physicians into the fold to ensure the policies they implement are designed to advance the quality of care for America’s patients in 2015 and beyond.”


Posted at 10:51AM Jan 05, 2015 by David Twiddy | Comments [0]

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The views expressed here do not necessarily reflect the opinions of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.

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