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Tuesday Jul 28, 2015

Physician Burnout: The AAFP Is Winning Battles For You

I have long been concerned about the impact of physician burnout on the health of our colleagues, our profession and ultimately our patients. Most of us realize that the issues of physician burnout are complex and involve factors related to personal resiliency (which can be addressed at the individual level), practice management (which must be addressed at the system level) and regulatory burdens (which must be addressed at the legislative level).

We all know burnout is a huge problem at a time when primary care physicians already are in short supply. Earlier this year, I wrote a blog noting that more than 40 percent of U.S. physicians experience at least one symptom of burnout (loss of enthusiasm for work, feelings of cynicism and a low sense of personal accomplishment). In that post, I wrote about the importance of managing stress, seeking support and removing the stigma associated with burnout.

Since then, additional blogs and editorials published by AAFP News have addressed personal resiliency. One blog post discussed the need to provide residents with resources to recognize, treat and prevent burnout. And we also have confronted the issue of physician suicide.

 AAFP President Robert Wergin, M.D., testifies about electronic health records during a Senate Health, Education, Labor and Pensions Committee hearing.

Although I am glad to see the increased awareness of burnout, I remain dismayed that many of the conversations about issues related to burnout reflect a sense of hopelessness. It is disheartening to realize the sense of frustration of some members who think the Academy isn’t willing or able to help. That being said, I can appreciate that our members on the front lines of primary care may be so busy in practice that they are unaware of all the activities that the AAFP is undertaking on our behalf.

The Academy is, in fact, working to change many of the drivers that lead to burnout, including payment reform and administrative burdens. Here's a look at the progress we've made on some critical issues this year.

Meaningful Use

The AAFP repeatedly called on CMS to ease the administrative burden associated with meaningful use. In April, CMS included two changes the AAFP advocated for in a proposed rule regarding stage 2 -- shortening the attestation period to 90 days and making requirements related to secure messaging with patients more attainable.

In March, the agency published it proposed rules for stage 3. The Academy pushed back, arguing that implementation should be delayed. Last week, the Senate Health, Education, Labor and Pensions (HELP) Committee agreed, and its chairman, Sen. Lamar Alexander, R-Tenn., called for a delay in enforcement of stage 3 requirements, which are scheduled to take effect in 2017.

The HELP committee has heard from both AAFP President Robert Wergin, M.D., and family physician David Kibbe, M.D., M.B.A., in recent months. Wergin spoke about the burden of electronic health records and the need for interoperability at a March hearing, and Kibbe spoke this month about business practices that impede information sharing(static1.1.sqspcdn.com).

The Academy also has seized opportunities for public comment and written letters to federal agencies in recent months regarding meaningful use stages 2 and 3 and the Office of the National Coordinator for Health Information Technology's interoperability roadmap. All of this correspondence has stressed the need for improvements in interoperability.

Finally, the Academy's Alliance of eHealth Innovation is conducting a study on the benefit and burden associated with meaningful use and is expanding its work on improving health IT usability and implementation.

SGR
For years, family physicians fought for the repeal of the Medicare sustainable growth rate (SGR), the faulty formula that repeatedly threatened to cut physician payments. On April 14, Congress finally passed the Medicare Access and CHIP Reauthorization Act, repealing the SGR formula. The law will provide needed payment stability in the Medicare program with several years of modest payment increases for physicians. The law also funds for two years the Children's Health Insurance Program, the National Health Service Corps, the Teaching Health Center Graduate Medical Education program and the federal community health centers programs.

The Academy will continue to communicate with HHS and CMS as they develop new payment models.

ICD-10
CMS announced this month that it will provide greater flexibility -- a one-year grace period from claims denials and audits -- during the transition to ICD-10 billing codes. The AAFP was one of numerous medical organizations that had written to CMS in March, urging further testing and risk mitigation.

Advance care planning

CMS recently released its proposed 2016 Medicare physician fee schedule. It discusses the establishment of advance care planning codes -- which the Academy has advocated for -- that would pay physicians for our expertise and time in assisting patients and their families with advance care planning services.

VA changes

The Department of Veterans Affairs (VA) announced in March that roughly twice as many military veterans will be eligible to see a physician who is not affiliated with the VA under a new standard for measuring the distance from a veteran's home to the nearest VA facility. The AAFP pushed for that change while also expressing continued concerns about VA payment rates being less than Medicare rates.

HPV testing

This spring, CMS proposed -- at the Academy's behest -- covering HPV testing in conjunction with a Pap smear test (once every five years for asymptomatic Medicare beneficiaries 30 to 65 years old who wish to extend the screening interval).

I know many challenges and frustrations remain. The increasing complexity and administrative burdens being placed on family medicine have been piling up for years. The Academy is committed to stopping this landslide.

The AAFP is continually communicating with Congress and federal agencies to ensure they know about these important issues. Legislators and policy makers must understand that transforming health care will require a strong family physician workforce, which in turn requires improving the health and wellness of our colleagues, and our practices, by decreasing the regulatory and system burdens that cause physician burnout.

Lynne Lillie, M.D., is a member of the AAFP Board of Directors.

Posted at 10:50PM Jul 28, 2015 by Lynne Lillie, M.D.

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