New Regulatory, Incentive Programs Provide Practice Challenges for Family Physicians in 2011

The year 2011 marked a time of great change for family physicians and the way they run their practices. The Academy -- and its wholly-owned subsidiary TransforMED -- stood ready to assist family physicians as they worked to transform their practices into patient-centered medical homes; implement electronic health records, or EHRs; and adjust to all the payment, coding and regulatory changes that are part and parcel of a new way of doing business.

And for some family physicians, efforts put forth in 2011 paid off in increased revenues via incentive payments made available through federal programs such as the Physician Quality Reporting System, the Primary Care Incentive Program, the Medicare Electronic Prescribing Incentive Program, and the Medicare and Medicaid Electronic Health Record Incentive programs.

One item at the top of the Academy's list in 2011 was a review of the AMA/Specialty Society Relative Value Scale Update Committee, or RUC. Recognizing that family physicians need to be fairly paid to keep their practices financially viable, the AAFP went on record in June strongly urging changes in the RUC's structure and process.

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.

In 2011, accountable care organizations, or ACOs, became rising stars in health care policy circles. In its simplest form, an ACO is a group of physicians and other health care professionals who have shared responsibility for the care of a group of patients and who simultaneously manage the quality and cost of that care.

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."

Health information technology, or health IT, went from being a bit player to commanding a starring role in health care in 2011 largely because of federal pressure on physicians, hospitals and other health care professionals to adopt EHRs as a means of improving the quality, efficiency and safety of health care.

In January, the federal government opened registration for an EHR incentive program for Medicare and another for Medicaid. The framework for both programs was included in the Health Information Technology for Economic and Clinical Health Act with the intention of promoting the adoption of health IT. HHS planned to entice physicians with the promise of incentive payments paid to physicians who adopted and used EHR technology in a meaningful way.

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.

The Academy stayed on top of federal regulations in 2011 and went to bat for members when rules were deemed too burdensome or physicians just needed more time to comply with regulations such as CMS' face-to-face patient encounter rule for home health care. The AAFP let members know when CMS updated the Medicare Advance Beneficiary Notice of Noncoverage form and alerted FPs to an upcoming change in the Medicare Audit Program.

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.