Each new year brings with it hopes, dreams and, yes, challenges. But before plunging ahead into 2015, family physicians have an opportunity here to glance back through 2014 and review many of the most pressing patient, practice and business issues the year had to offer.
Interestingly, even before the first sunrise of 2014, Medical Economics predicted a year of daunting challenges for small office-based practices and yet suggested America's physicians assume a proactive stance as they considered ways to "re-create, "evaluate," "maximize" and "re-engineer" their practices.
Steven Waldren, M.D., director of the AAFP's new Alliance for eHealth Innovation, looks forward to seeing family physicians embrace health information technology products as indispensable support systems in their practices.
In retrospect, one might call those words prophetic.
ONC, AAFP Sharpened Technology Focus
As physicians became increasing reliant on and comfortable with health information technology, HHS' Office of the National Coordinator for Health IT (ONC) released a 10-year work plan designed to ensure the country would have access to an interoperable health IT infrastructure in the future.
The ONC called interoperability a "national priority," and the AAFP, a stalwart proponent of health IT and, more specifically, of electronic health records (EHRs), followed soon after with its own announcement that its decade-old Center for Health IT had transitioned to become the AAFP's Alliance for e-Health Innovation.
Steven Waldren, M.D., director of the Alliance, noted the Academy's intention to redirect its resources toward achieving EHR usability and interoperability. In an interview with AAFP News, Waldren said EHR functionality should improve to the point that family physicians trusted the technology to reliably complete tasks such as drug overlaps and inconsistencies and, ultimately, become "just one more piece of an efficient practice process."
Forward momentum on the EHR front was tempered by ongoing concerns about government programs intended to increase physician usage of the technology. Topping the list were HHS' Medicare and Medicaid Incentive programs.
The AAFP worked to guide the ONC toward solutions to troublesome issues surrounding health IT certification and, throughout 2014, urged HHS to modify its meaningful use timelines and requirements. The Academy also worked to ensure that family physicians were aware of the multiple delays and extensions the programs experienced.
ICD-10 Implementation Date Finalized
One particularly significant deadline shift this past year involved the date for implementation of the ICD-10-CM code sets for outpatient diagnostic coding. In February, the AAFP again raised serious questions about ICD-10 testing and readiness, particularly among small and medium-sized physician practices.
And although the implementation date had already been rolled back to Oct. 1, 2014, (then) AAFP Board Chair Jeff Cain, M.D., of Denver, argued for a further extension. Legislation enacted on April 1(www.congress.gov) did indeed give physicians until Oct. 1, 2015, to prepare for the transition.
FP Eugene Heslin, M.D., relies on health information technology and coordinated team-based care to ensure his patients receive quality care.
With that news, the AAFP stepped up its already extensive efforts to provide the resources family physicians needed by adding a free webinar to augment existing tools such as ICD-10 flash cards, a timeline, a cost calculator and a list of frequently asked questions on the topic.
Practice Innovations Flourished
The patient-centered medical home (PCMH) continued to thrive in family medicine practices around the country despite one less-than-stellar report on the model in JAMA: The Journal of the American Medical Association in February. (Then) AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., pointed out that more recent research showed far better outcomes and lower costs, and he agreed with the study's lead author that continuing research on the model was the appropriate course of action.
Meanwhile, many family physicians embraced the PCMH model. Take Eugene Heslin, M.D., of Saugerties, N.Y., whose practice was part of a PCMH-EHR study group in the Hudson Valley area. He told AAFP News in June that combining a robust EHR with coordinated team-based care was improving the quality of care he provided to his patients.
FP Donald Clark, M.D., of Dayton, Ohio, told AAFP News he employed risk-stratified care management -- a method of identifying high-risk, high-cost patients -- as the first step toward improving efficiency in his practice.
And family physicians Keith Davis, M.D., of Shoshone, Idaho, and Lynn Fisher, M.D., of Plainville, Kan., reported that they were teaming quite successfully with nonphysician health professionals to ensure that patients in their rural communities had access to care.
Finally, when research published in August by the Journal of the American Board of Family Medicine suggested physicians should forge their own paths in seeking creative ways to make their practices more efficient, Christopher Hawley, M.D., of Turlock, Calif., told AAFP News that his practice was doing just that.
"Change is always hard, no matter what," said Turlock, "but if the answer to your 'Why change?' question is not inspiring and compelling, it won't be enough to push you through those really difficult pieces that are necessary in any sort of transformative change."
Angela Kerchner, M.D., of West Branch, Iowa, (left) and Erika Levis, M.D., of Pleasant Hill, Iowa, listen carefully as other family physicians share their ideas about direct primary care; both are new to practice and already disillusioned and ready for a change.
The direct primary care (DPC) movement grabbed the interest of family physicians nationwide in 2014. This innovative practice model calls for physicians to charge patients a flat monthly or annual fee in exchange for a broad range of primary care services.
In fact, in response to member demand, the AAFP hosted its first DPC workshop in November. Nearly 40 family physicians from 16 states traveled to Phoenix to spend an entire day learning more about the model, asking questions of experts and interacting with one another.
"We're looking at transitioning into this type of model and whether it's realistic for us," said workshop attendee George Payne, M.D., of Farmington, N.M. "We want to understand the pitfalls so we don't step into them as we go along."
The AAFP has additional DPC workshops and member resources planned for 2015.
Payment Issues Garnered Attention
The AAFP jumped immediately into physician payment issues this past year with a Jan. 23 letter asking CMS to review and correct misvalued CPT codes.
In April, despite earlier AAFP objections, CMS announced that it had made public a data set of information detailing physicians' billing and Medicare details.
Blackwelder, however, was able to point out the positives for AAFP News. "When that data set is further mined and studied, it won't be difficult to make the case -- using hard evidence -- that family physicians provide comprehensive and time-intensive health care to their patients, and, yet, are near the bottom of the list in terms of payment for those services," he said.
And in July, the AAFP, in collaboration with the Medical Group Management Association (MGMA), took steps to halt the misuse by some employers of MGMA survey data when creating physician compensation packages.
Mid-summer also marked the release of the proposed 2015 Medicare physician fee schedule, and in usual fashion, the AAFP spent months scrutinizing the document and urging CMS to consider changes that would more favorably impact payment for family physicians.
And when the final fee schedule was released in November, the AAFP summarized the key points pertinent to family physicians.
One highlight of the 2015 schedule was CMS' decision to implement a new chronic care management (CCM) code. The Academy had fought hard for the creation of such a code, and AAFP President Robert Wergin, M.D., of Milford, Neb., called its inclusion in the fee schedule "a step toward recognizing the value of the often complicated clinical oversight that -- although needed by many Medicare beneficiaries -- requires significant clinical time outside the exam room."
Accordingly, the AAFP immediately took steps to ensure that family physicians understood the intricacies of the new CCM code, including via a package of tools and resources Family Practice Management pulled together to guide them. AAFP members can expect more help on the CCM front early in 2015, including guidance on how to talk with their patients about why it is an important part of their care.
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