President's Message

Fighting for Change as Only a Family Physician Can

November 09, 2016 10:49 am John Meigs, M.D.

A longtime AAFP member recently reached out to me with concerns about the Medicare Access and CHIP Reauthorization Act (MACRA). Specifically, she was worried about how the new law and its emphasis on value-based payment will affect family physicians already experiencing symptoms of burnout, and whether it might prompt some physicians to flee direct patient care, exacerbating the primary care shortage.

Here I am taking notes during a patient exam. AAFP officers are well aware of the administrative burdens family physicians face and are working to reduce such distractions from patient care.

She also had concerns about what she perceived as the "level of detachment" AAFP leaders have from the impending regulations.

I already responded directly to this member, but I thought I should share my thoughts more broadly because this is an important issue that will affect most of our membership.

First, I share your frustrations. I, too, experience the administrative hassle and regulatory burden of modern medical practice every day. I owned a private solo practice in rural Alabama for 31 years. For the past three and a half years, I have been in practice with another family physician and two part-time certified registered nurse practitioners. I see patients every day that I am not traveling for the Academy to make the case for administrative simplification and regulatory relief. We know the administrative complexity of modern medicine is a leading cause of physician burnout and frustration.

MACRA is a complex law, and it will require work from all of us. However, if you have already been reporting quality measures under the Physician Quality Reporting System and/or have participated in meaningful use, then you are already meeting some MACRA requirements. If you have been involved in clinical improvement reporting -- such as through the Family Medicine Certification process (formerly known as Maintenance of Certification for Family Physicians), or perhaps through insurance plan requirements -- then you are already doing the kinds of things that MACRA will require.

Please remember that MACRA repealed and replaced the Medicare sustainable growth rate (SGR), the flawed formula that annually created potential pay cuts of 20 percent or more and left physicians at the mercy of Congress to provide relief (which almost always came at the last minute).

With MACRA, we have the stability of knowing what to expect, and the potential of increased payments and even bonus payments (along with the possibility of negative updates). If you participate in "pick-your-pace" at any level of participation in 2017, you will avoid potential penalties in 2019, the first year of MACRA implementation. The MACRA updates in 2019 start as high as 4 percent (plus or minus) and go up slowly each year, but they come nowhere close to the cuts we faced under the SGR.

We have long made the case to CMS and the commercial insurance industry that family medicine and primary care need and deserve to be paid differently and better. With MACRA, we have the different part, and we are working every day for the better part. I believe that payments to family medicine based on quality and value will be much more beneficial to us than the fee-for-service, volume-based system in which we currently operate.

Change is always difficult, but change is also a constant. We struggle as we try to survive in the old system while moving toward the new value-based model, which offers us the potential to be paid more appropriately for what we bring to our patients and the health care system as a whole.

The AAFP's dedicated and conscientious staff members go to work every day to try to make our lives and our work situations better. The Academy's officers and directors also work diligently on your behalf to correct the problems we know exist. We don't win every battle and we don't get everything we wish for, but we do get some wins. For example, the pick-your-pace program I mentioned is based on suggestions the AAFP made to CMS. That really is a big win, and members who participate at any level in 2017 -- even if it is just to test the Quality Payment Program -- will not face penalties in 2019. That gives us another year to transform our practices and for the system itself to continue the transition to one that more properly rewards the value we do indeed bring to the system.

Keep up the good work you do to improve the lives of your patients and the health of your communities. The AAFP will continue its efforts to make sure that the good work that you, and all of us, do is properly valued and appropriately rewarded.