Family Physicians Raced to Keep Pace With Practice Changes, Regulations

Family physicians saw some doors swing open in 2012 as major players in America's health care system set to work planning for implementation of the 2010 Patient Protection and Affordable Care Act. A variety of new payment models -- primarily designed to benefit primary care physicians -- went into testing mode, and phrases such as accountable care organization (ACO) and Comprehensive Primary Care (CPC) initiative became mainstream in health care circles.

Although 2012 was a time of great opportunity for physicians, the year also symbolized escalating work-related stress. Busy family physicians were taking care of sicker patients with less spendable income, while at the same time struggling to understand federal regulations with schizophrenic deadlines.

Here's one last look at 2012's most notable news on how family physicians went about their daily business -- and how the AAFP assisted in those efforts.

Since 2005, the Academy has focused a good amount of time, energy and money on furthering the patient-centered medical home (PCMH) model of care, and, in 2012 those efforts began to pay off.

Research was published that suggested physicians practicing primary care in PCMH practices had higher morale levels and increased job satisfaction even though the hard work of practice change took a toll on some physicians, who experienced "burnout" on the job.

To prove to FPs that the PCMH model was indeed a viable option, AAFP News Now visited a family medicine practice in Colorado to highlight the work going on there. The three-part series traced one family physician's journey as he transformed his practice and saved his family medicine career in the process.

The U.S. military also discovered the benefits of the PCMH model of care, and, in 2012, the nation's armed forces and the U.S. Department of Veterans Affairs began the process of transforming thousands of practices to better serve military patients and their families.

Yet, even as private insurers announced pilot programs aimed at providing higher pay for primary care physicians operating PCMH practices, family physician delegates at the 2012 AAFP Congress of Delegates took to the microphones to stress the need for more PCMH cost data and additional guidance from the AAFP.

CMS spent much of 2012 fulfilling directives associated with the health care reform law, and the AAFP focused on keeping members informed about new opportunities available to them.

For example, in March, CMS released the names of the first 27 ACOs chosen for its Medicare Shared Savings Program, and, in June, the AAFP alerted physicians that new money was available to them through CMS' Advance Payment ACO Model Program.

CMS' CPC initiative created quite a stir when the project was announced in the spring. It held the promise of a real breakthrough in a blended payment methodology for nearly 500 primary care practices in seven markets around the country. Ultimately, about 1,300 family physicians were chosen to participate in the multipayer demonstration project.

In August, CMS began addressing physician questions about the agency's plans to implement a value-based modifier payment. And after numerous false starts, the compliance date for the ICD-10-CM code sets for outpatient diagnosis coding finally was set for Oct. 1, 2014.

Meanwhile, the AAFP began readying tools and articles to prepare its members for ICD-10. The system change will explode the number of diagnosis codes available to physicians from about 13,000 codes to more than 68,000 codes.

In 2012, physicians' use of electronic health records (EHRs) was connected to enhanced payment opportunities -- as well as penalty pitfalls -- in an ever-increasing manner.

Just as family physicians were getting comfortable with the requirements outlined in stage one of HHS' regulation on the meaningful use (MU) of EHRs, MU stage two requirements were released. The AAFP actively participated in refining the final rule -- released in early September -- to make it more achievable for family physicians.

Unfortunately, even as MU incentive money flowed into many physician practices, some FPs reported snags in the actual allocation of such funds. Practice owners and employed physicians alike had problems, and financial and legal experts weighed in on the issues connected with earning and disbursing quality-based payments.

Many FPs moved full speed ahead with electronic prescribing, but some Medicare participating physicians who were unable or unwilling to do so were stung with a 1 percent penalty as part of Medicare's Electronic Prescribing (eRx) Program.

CMS gave physicians until June 30 to file for an eRx hardship exemption and then expanded those hardship exemptions later in the summer.

Still, even as many family physicians continued to weigh the pros and cons of their increasing reliance on EHRs, most agreed that the technology was here to stay. To help FPs make the best choices in product selection, Family Practice Management produced the fifth iteration of its EHR User Satisfaction Survey.

The 2012 survey collected reviews and comments from 3,088 family physicians, the largest number of FPs ever to respond to the survey request.

For all the federal government's good work, the myriad of programs and regulations it generated and then channeled through HHS, CMS and other agencies at times left physicians frustrated.

For instance, HHS attempted to streamline administrative tasks performed by physician practices and, in August, published the third in a series of regulations in 2012 dealing with electronic transfers of health information.

The billing and insurance-related work the government was trying to eliminate for physicians reportedly consumed the equivalent of three work weeks per physician practice each year. But interpreting and implementing the new regulations created a burden for physicians, too.

And even though a provision of the ACA that provided additional preventive services to Medicare patients was a plus for seniors, the volume of patients who requested those services -- as well as intricacies involved in coding and billing (4-page PDF; About PDFs) for them -- stressed some physician practices.

Furthermore, CMS' recovery audit contractors (RACs) continued to expand their reach throughout the year. In August, CMS launched a RAC demonstration project aimed at stopping improper Medicare fee-for-service payments before they were made to hospitals and physicians. Then came CMS' late-summer announcement that RACs would begin auditing physician claims with higher-level CPT codes for the evaluation and management services most often performed by FPs.

In 2012, TransforMED, a wholly owned nonprofit subsidiary of the AAFP, made inroads into critically important areas such as practice transformation and payment reform.

The organization worked with clients ranging from individual family medicine practices to large hospital groups and insurance company pilot projects. But throughout the year, TransforMED looked for ways to answer family physicians' questions about what it took to be a PCMH practice.

For example, early in 2012, TransforMED launched a tool called the Medical Home Implementation Quotient 3 -- an enhanced version of its free online assessment tool designed to help physicians measure their progress toward achieving PCMH recognition.

The AAFP and TransforMED also agreed that all Academy members needed free access to TransforMED's Delta-Exchange physician networking resource. Delta-Exchange provides a venue for busy physicians to ask questions, engage in discussions with expert sources and view webinars on timely topics.

Delta-Exchange served thousands of AAFP members in 2012.