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2011: The Year in Review
New Regulatory, Incentive Programs Provide Practice Challenges for Family Physicians in 2011
By Sheri Porter
Focus on the RUC
The AAFP and many of its members have long argued that the RUC, which acts as an expert panel and makes recommendations to CMS on the relative values of CPT codes, undervalues the preventive care services and chronic disease management provided by primary care physicians.
In June, the AAFP asked the RUC to make a number of organizational changes, including a reconfiguration of the seats on the committee and implementation of voting transparency. The Academy wants a decision on these issues by March 1, so AAFP Board Chair Roland Goertz, M.D., M.B.A., of Waco, Texas, traveled to Chicago in September to address the RUC's administrative subcommittee regarding the changes. After the meeting, Goertz said, "Without telling the RUC exactly which path to take, I think we have made our case. Now it's up to them."
In the meantime, the Academy worked on creating a task force that will review and make recommendations to the AAFP Board of Directors on an alternative methodology to value evaluation and management services provided by family physicians and other primary care physicians. The Primary Care Valuation Task Force, which met for the first time in late August, includes experts in health policy and research who represent employer and patient groups, as well as the medical community and health plans. Task force members were chosen from both within and outside the Academy.
The Academy worked diligently to ensure that family physicians understood the pros and the cons of affiliating with an ACO. The AAFP created a frequently asked questions document and partnered with TransforMED to co-host a free webinar on ACOs. In addition, the AAFP and six constituent chapters collaborated with a North Carolina-based law firm to produce a set of ACO resources for family physicians.
In October, HHS issued its final rule on Medicare ACOs, and the AAFP was pleased to see that the final version reflected a number of Academy recommendations. For example, the AAFP pushed for and got language that lets primary care physicians participate in multiple Medicare ACOs. The final rule also cut the number of individual quality measures that are used to determine whether an ACO qualifies for shared savings from 65 measures to 33 measures.
In November, the AAFP wrote a summary of the final rule (19-page PDF; About PDFs) that provides AAFP members with an overview of the segments of the lengthy rule that could affect them.
On a related topic, the Center for Medicare and Medicaid Innovation announced its new Comprehensive Primary Care Initiative in late September, and AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., immediately issued a statement calling the program "an important breakthrough in reforming our health care policy."
Implementing Health Information Technology
The Academy was proud to announce in May that FP Jennifer Brull, M.D., of Plainville, Kan., was one of the first physicians in the country to successfully attest to CMS' EHR meaningful use requirements, and on May 25, Brull received an $18,000 bonus check from CMS.
Recognizing that some members would not be able to meet CMS' requirements for e-prescribing, however, the Academy supported additional hardship exemptions for physicians participating in the agency's Medicare Electronic Prescribing Incentive Program, and CMS agreed. But, in 2012, the agency still will begin penalizing physicians who did not apply for an exemption or who are not deemed e-prescribers. Medicare payments to those physicians will be reduced by 1 percent in 2012, 1.5 percent in 2013, and 2 percent in 2014.
The AAFP also ramped up efforts to ensure members were ready for the Jan. 1, 2012, implementation of the 5010 transaction codes sets for the transfer of electronic health information data. The standards are mandated by a provision of the Health Insurance Portability and Accountability Act.
AAFP members were alerted to 5010 testing dates, encouraged to set up contingency plans in the event their practices were not ready for the Jan. 1 deadline, and frequently reminded that practices that were not ready to submit and receive electronic claims and other electronic transactions in the new 5010 transaction format would almost certainly experience cash flow problems come 2012.
Another big change looms on the horizon for physicians with the switch to the ICD-10-CM code sets on Oct. 1, 2013. Although that deadline is many months away, much preparation is required of physician practices, and so the Academy kept the issue in front of members with the release of numerous resources to help with the transition.
During the past year, AAFP members also saw the launch of the Academy's clinical data repository pilot project in March and were introduced to AAFP Physicians Direct -- a secure messaging service -- in June.
Easing Federal Regulatory Burdens
In June, the AAFP told HHS to cut the clutter and trim some of the more burdensome regulations that too often negatively affect family physicians. (Then) AAFP Board Chair Lori Heim, M.D., of Vass, N.C., chided HHS for subjecting all physicians to multiple documentation and certification requirements in an attempt to catch criminals who commit fraud against the Medicare and Medicaid programs.
In addition, Heim asked HHS to update the Medicare economic index; streamline the claims review process; issue regulations that fully implement the administrative simplification provisions called for in the health care reform law; and harmonize all aspects of the Physician Quality Reporting System, the Medicare Electronic Prescribing Incentive Program, and the Medicare and Medicaid Electronic Health Record Incentive programs. Heim also called on HHS to develop a comprehensive and understandable physician signature policy for the Medicare program.
FPs Faced Many Practice Challenges in 2011