Marie-Elizabeth Ramas, M.D., spent four years talking to her hospital system about the patient-centered medical home (PCMH). When her employer finally transitioned to electronic health records (EHRs) -- a key component of the PCMH -- it purchased and began implementing its electronic health record system with little input from its practicing physicians.
Marie-Elizabeth Ramas, M.D., of Mount Shasta, Calif., talks about the challenges associated with electronic health records (EHRs) at a Town Hall meeting. Smith said during the Sept. 27 event in Denver that her EHR has significantly hindered her productivity.
"I can tell you that over the last three months my clinical productivity -- my ability to take care of patients -- has dropped by a third," said Ramas, who runs a rural health clinic in Mount Shasta, Calif. "People's health is endangered."
Ramas was one of a handful of AAFP members who expressed frustrations related to EHRs during a Sept. 27 Town Hall meeting here. Ramas said she met with hospital administrators to discuss the EHR's shortcomings and was called "combative and aggressive."
"They basically said, if you can only see seven patients a day, see seven patients," she said. "I said, 'I'm here to take care of my community and the people who need to be taken care of.'"
Ramas, who is the incoming new physician member of the Academy's Board of Directors, drew loud applause from the standing-room-only crowd for her impassioned story.
"Thank you for being disruptive and combative," quipped AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn.
"And we look forward to your year on the Board," added Speaker John Meigs, M.D., of Centreville, Ala.
Ramas asked AAFP officers how a solo physician can make his or her voice heard when dealing with large health systems, payers and other large entities.
AAFP President Robert Wergin, M.D., a solo physician in rural Milford, Neb., sympathized.
AAFP President-elect Wanda Filer, M.D., M.B.A., of York, Pa., answers a question during the meeting. Filer, Board Chair Reid Blackwelder, M.D., (left) and president Robert Wergin, M.D., (center) fielded questions on a wide variety of topics.
"I wish I could say you have a unique experience," he said, "but I can see a lot of heads nodding in this room."
However, Wergin said there is strength in numbers when solo and small-practice physicians work together through issues such as accountable care organizations (ACOs) or independent practice associations. Wergin cited as an example Nebraska AFP President Joe Miller, M.D., of Lexington, who also spoke during the meeting.
Miller said his primary-care based organization was eighth out of 353 ACOs in quality rakings. He said that although quality metrics and EHRs are "hassles," there are payers who are willing to make the added work worthwhile.
"We have done phenomenal things," said Miller. "I'm more excited about being a family physician than I ever have been in 31 years of practice. We have to do it right, and we have to get word out to colleagues. We have a chance right now to make family medicine the best specialty in everyone's mind, not just ours."
Blackwelder said the Academy is working on issues related to EHRs, including interoperability and meaningful use.
"We're talking to the right people about how incredibly asinine this is and how it has to change," he said. "And we have to change the penalties from us to vendors. We have to have other people have skin in game."
Blackwelder also said the AAFP needs help from members.
"If your legislators have not heard the stories about your clinic EHR, your hospital EHR, your pharmacy and your subspecialists' EHRs not communicating, they need to hear it," he said.
AAFP President-elect Wanda Filer, M.D., M.B.A., of York, Pa., pointed out that one way members can do exactly that is by participating in the Academy's Speak Out efforts.
EHRs were just one of many topics covered during the meeting. The Medicare Access and CHIP (Children's Health Insurance Plan) Reauthorization Act (MACRA) also was discussed. That legislation replaced the flawed Medicare sustainable growth rate (SGR) formula in April.
Under MACRA, physicians participating in Medicare will receive 0.5 percent annual increases in their payments for the next few years. Starting in 2019, physicians will have the option of pursuing payments through alternative models (such as the PCMH) or by staying in the fee-for-service system.
AAFP EVP and CEO Douglas Henley, M.D., said the Academy and its constituent chapters are embarking on a significant educational and informational campaign about that upcoming process, and the Academy is developing resources to help family physicians prepare for the decision.
Wergin said that although he celebrated the demise of the SGR, he acknowledged that the Academy's work is not done, and the AAFP will work to influence the regulatory and rule-making process as MACRA is implemented.
Henley said one important factor in that process will be the Health Care Learning and Action Network that CMS announced earlier this year. The Academy is the only medical organization that has representation in that body.
Similarly, the Academy is the only physician group participating in the Health Care Transformation Task Force, which is a consortium of patients, payers, providers and purchasers seeking to align private and public sector efforts to transform the U.S. health care system.
"I hope you heard a theme," said Blackwelder, who is the AAFP representative to the CMS committee. "We're the only physician group invited. We're the only organization represented. That's really critical in this regulatory process. The more we get to the table, the more likely we are able to have an impact."
In response to a question about Medicaid expansion -- or lack thereof in some states -- Filer said the Academy likely will be the only medical group participating in the Southern Governors' Association annual meeting Oct. 15-16 in St. Louis. The AAFP already sent representatives to the Western Governors' Association in June.
"We're going to talk about the importance of everyone having coverage," Filer said. "That's been our policy -- health care for all -- for quite some time. My hope is to carry that message."
Karen Smith, M.D., of Raeford, N.C., discusses chronic care management during the meeting. Smith said that copays are a barrier to patients accessing the service.
Chronic Care Management
Karen Smith, M.D., a solo physician from Raeford, N.C., said the $8 patient copay associated with the new chronic care management code is hurting patient engagement.
"We're advocating vigorously to get rid of the patient payment component," Filer said to enthusiastic applause.
Despite the copay, Hugh Taylor, M.D., said his practice in South Hamilton, Mass., has signed up 150 patients, "and it's been well received." He added that the Academy "really stepped up to the plate and provided very useful info about how to implement it and make it work. That's the kind of help we need."
In other news:
- ICD-10 implementation begins Oct. 1. Blackwelder reminded the audience that the Academy has resources to help.
- Graduate medical education (GME) was discussed at length. Filer commented that AAFP advocacy efforts had led more than two dozen members of the House to request a Government Accountability Office study on GME financing. The analysis will determine whether the significant amount of tax dollars invested in physician education is succeeding in producing the workforce the country needs. "We know the answer to that," she said. "It's not."
- Brian Bachelder, M.D., of Akron, Ohio, requested help with prior authorizations, commenting that one payer in his state is requiring that burdensome step for transitions of care. Henley said prior authorizations likely will continue as long as fee-for-service is the predominant model of payment, but he said there are efforts to bring payers together to "harmonize those types of requirements and make it simpler."
- Robert Jackson, M.D., president-elect of the Michigan AFP, questioned how family physicians can help rein in health care spending. Filer pointed to Rhode Island, which required payers to increase the percentage of their health care spending on primary care. The state's overall health care costs dropped dramatically. "It absolutely showcased our value," she said. "So we and our partners in the Patient-Centered Primary Care Collaborative are saying, 'How do we replicate this model around the country? How do we put primary care back in charge of that health care dollar?' It puts us back in focus in the center of the health care system. Our subspecialty colleagues are nervous and with damn good reason."