The AAFP took full advantage of a recent opportunity to tell HHS what it thinks about overarching and burdensome federal regulations that make it harder for family physicians to provide health care to millions of Americans.
After HHS published a request for public comment on its next phase of retrospective review of regulations(www.gpo.gov) in the Sept. 13 Federal Register, AAFP Board Chair Jeff Cain, M.D., of Denver, responded with an Oct. 10 letter to HHS Secretary Kathleen Sebelius in which he zeroed in on specific problematic regulations, some of which the Academy has been bucking for several years.
For example, Cain once again stated the AAFP's objections to implementation of the ICD-10-CM code set for outpatient diagnosis coding. He said that even though the AAFP continues to prepare members for transition to the new system of 68,000 codes, "We are still concerned it will create a significant burden on the practice of medicine with absolutely no direct benefit to individual patient care."
The AAFP has joined with a number of other medical organizations to call on HHS to stop implementation of ICD-10.
- HHS requested public input on its retrospective review of burdensome or inefficient HHS regulations that could be modified or eliminated.
- In a letter to HHS Secretary Kathleen Sebelius, the AAFP pointed out flaws in a number of existing rules that cost family physicians time and money.
- The AAFP also reiterated its long-standing argument that the country needs more family physicians and that they deserve better pay for the services they provide to patients.
In addition, Cain pointed to the enormous costs physicians bear in providing medical translator services to Medicare and Medicaid patients. He called on HHS to permit interpreters to bill federal and private health plans for the services, and, "if applicable, treat this as a change in law and regulation for purposes of the physician payment update formula."
The AAFP also chided HHS for its often overlapping documentation and certification requirements, which, admittedly, were instituted in a good-will effort to fight fraud in Medicare and other public programs. However, "Navigating these requirements successfully takes considerable time away from patient care," said Cain. "Instead of treating all physicians as if they are criminals until proven otherwise," HHS should develop policies that target repeat offenders.
The Academy called prior authorization phone calls, faxes and paperwork "time wasted" for busy medical practices. "Frequent formulary changes by the health plan(s) and their time-consuming preauthorization requirements impede the practice of medicine," said Cain. He called on HHS to require that all plans use a standard prior authorization form and to prohibit prior authorizations for ongoing use of drugs and supplies by patients with chronic disease, among other things.
Cain also urged HHS to improve the Medicare physician enrollment process, calling it the "largest and most persistent source of physician frustrations" with Medicare. "All too often, physicians wait several months for CMS contractors to process an enrollment application, and these delays cause severe financial hardships for their practices," said Cain.
The AAFP acknowledged the difficulties inherent in creating fair and sound regulations that too often are prone to unintended consequences. Unfortunately, said Cain, many HHS regulations "place unfunded financial mandates on physicians and the medical practice businesses that employ them."
In addition, the AAFP called on HHS to
- streamline and coordinate claims review processes currently conducted by multiple HHS contractors,
- implement administrative simplification processes included in the Patient Protection and Affordable Care Act immediately,
- reevaluate signature requirements associated with insurance payers' requests for additional documentation, and
- free physicians from the current complicated requirements for prescribing supplies for patients with diabetes.
Cain also used his letter to HHS to reiterate the AAFP's long-standing cry for more appropriate pay for family physicians, who provide high-quality care to patients at a lower cost than could be provided by subspecialty physicians or in the nation's ERs and hospitals.
He reminded Sebelius of the need to recruit more medical students to family medicine and noted that better pay could serve as an incentive. "We urge HHS to consider the innovative primary care physician payment recommendations outlined in our Aug. 29 letter," said Cain.
In that letter, the AAFP argued for the creation of separate primary care evaluation and management codes for office or other outpatient services to patients. "The complexity of the ambulatory evaluation and management services that primary care physicians must 'fit' into the time available for the typical patient visit is sufficiently distinct to merit dedicated codes and higher relative values," said Cain.
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