2013: Year in Review

Family Physicians Embraced Health IT, Worked Through Challenges, Cheered Success

January 02, 2014 10:47 pm News Staff

Although 2013 was a tumultuous year for everyone involved in health care, physicians in particular were challenged to keep up with a revolving door of federal regulations, deadlines, extensions of those same deadlines, and a myriad of new experiences with practice and payment methods.

FP Dave Eitrheim, M.D., gives Mary Knops his full attention and all the time she needs as he draws out the patient's health concerns during a relaxed office visit made possible by the implementation of clinic efficiencies.

Throughout the year, the AAFP stood ready to help family physicians understand all that was thrown at them, and with each new challenge, the Academy worked relentlessly to provide tools and resources to help members so they could focus their time and efforts on taking care of patients.

So let's say goodbye to 2013 before ringing in a brand new 2014.

New Practice Methods, Payment Models Flourish

The patient-centered medical home became a mainstream term in 2013 as physicians, patients and policymakers realized that the model really could improve health care quality and save money as noted in a Commonwealth Fund report issued in January.

A related term, the patient-centered medical neighborhood, emerged, in part, from the promise of more robust health information technology. Family physicians began to trust and rely more heavily on health IT as a means to partner with their subspecialist colleagues and hospitals and provide seamless health care transitions for their patients.

Phrases such as team-based care, health coaching, chronic disease management and patient self-management -- although not necessarily new to seasoned family physicians -- became media darlings as health care policymakers looked for ways to improve patient care and cut health care costs.

Accountable care organizations (ACOs) spread like wildfire across the country. In January, CMS announced the establishment of 106 new ACOs, and the AAFP was pleased to note that family physicians and their patients were among those who would benefit.

Family physicians around the country embraced a new practice model called direct primary care (DPC) in which practices charge patients a monthly fee in exchange for access to a broad range of primary care service. Physicians who dive "all-in" into this model typically do not take insurance but encourage patients to carry high-deductible catastrophic plans to cover hospitalization and other high-cost medical care.

(Left to right) Michael Palomino, M.D., who joined Atlas MD on May 6, pauses for a moment with colleagues Doug Nunamaker, M.D., and Josh Umbehr, M.D.

In May, the AAFP created its first DPC policy, and based on intense member interest in the model, also developed a document to answer family physicians' most pressing questions(4 page PDF).

Billing Challenges Compete for Physicians' Time

Billing and payment hurdles never seem to lessen for physicians. Even as medical practice executives listed operating costs as their top medical practice concern in 2013, physicians raced to keep up with CPT code changes that, at times, proved challenging for practices with slim profit margins.

Those changes from CMS included new codes for transitional care management and CPT code edits -- initiated through the National Correct Coding Initiative -- that played havoc with physicians getting paid for evaluation and management services billed on the same day as vaccine administration.

Many family physicians closely followed the AAFP's April request to CMS asking the agency to create new evaluation and management (E/M) codes for primary care physicians. Although those new E/M codes were not included in the 2014 Medicare Physician Fee Schedule, the Academy vowed to continue that debate.

In December, the AAFP summarized for members the key provisions of the 2014 Medicare physician fee schedule, which included a number of positives for FPs, including a chronic care management code that will be available for use beginning in 2015.

Health Information Technology Takes Off

An Annals of Family Medicine study published early in the year called attention to the fact that family physicians continued to outpace other office-based physicians in adopting electronic health records (EHRs). According to one research expert, family medicine's wide scope makes EHR technology particularly appealing to physicians in the specialty.

By the end of 2013, authors predicted four out of five FPs would implement an EHR and that health IT would increasingly play a role in the management of large patient populations.

David Voran, M.D., a family physician in Platte City, Mo., and long-time proponent of health information technology, relies heavily on his electronic health record to provide the best possible care to his patients.

In June, AAFP News Now scored an interview with Farzad Mostashari, M.D., the country's (then) national coordinator for health IT. Mostashari said the push for EHR implementation should go hand-in-hand with new payment models to allow physicians to see a financial return on their technology investment.

Federal Regulatory Burdens Continue

The government's alphabet soup of regulation -- HIPAA, ICD-10, MU, eRx -- rolled along unabated in 2013, and the AAFP kept physicians informed of deadlines every step of the way.

For example, final regulations for the Health Insurance Portability and Accountability Act (HIPAA) omnibus rule were published in January, and physicians needed to be ready to comply with privacy and security rules by Sept. 23.

Even though the AAFP and many other physician advocates urged CMS to halt or delay implementation of the ICD-10-CM codes sets for outpatient diagnosis coding, the agency held firm to its Oct. 1, 2014, implementation date.

In response, the AAFP set to work to prepare members by offering educational resources such as a webinar and a set of ICD-10 flash cards to help members transition to the new codes.

Electronic prescribing (eRx) was a moving target for physicians as CMS shifted deadlines by which physicians could request hardship exemptions to avoid a 1.5 percent Medicare pay cut in 2013.

[Stethoscope laying on calendar indicating delays in MU stage 3 rule-making]

Meaningful use (MU) of EHRs -- stages one, two and three -- continually made news headlines in 2013 as the Academy fought for delays, revised compliance deadlines and even coached physicians on how to survive an MU audit.

With so many government programs in full swing simultaneously, the AAFP created a one-stop shop where family physicians could see all the pertinent information at a glance in a Web page titled "Medicare Initiatives: Bonuses and Penalties."

High Notes Worth Celebrating

As 2013 rushed along, there was good news for family medicine, too. For example, a survey released by the MGMA (formerly the Medical Group Management Association), revealed that national demand for family physicians was fueling salary and compensation increases.

The survey showed that median first-year guaranteed compensation for FPs not doing obstetrics jumped from $163,000 in 2011 to $170,000 in 2012. Other prominent surveys mirrored those results.

In September, a Merritt Hawkins survey showed that family physicians topped the list of the most highly recruited physicians for the seventh straight year. The survey findings affirmed the dominance of family medicine in the nation's evolving health care system.

But the most gratifying news of all came late in the year when new survey results released on Dec. 18 revealed that, by a wide margin, Americans want physicians handling their health care.

In fact, 72 percent of American adults surveyed by Ispos, a global market research company, said they preferred physicians to nonphysicians, such as nurse practitioners, when it came to their health care.

Furthermore, 90 percent of adults would choose a physician to lead their "ideal medical team" when given the choice, and by a greater than a two-to-one margin, adults viewed physicians and family physicians as more knowledgeable, experienced, trusted and up-to-date on medical advances than nonphysicians.

AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., called the news "outstanding."

He told his physician colleagues, "Finally, we have a survey from patients that says they not only value primary care, they value you for your education, expertise and experience."

"As family physicians, we not only are a critical part of the health care team, we are the identified leader of the teams, and that's what our patients want and expect."