Happy New Year! As the calendar turns from 2015 to 2016, it's important to outline priority issues and areas of focus for the AAFP heading into the New Year.
As noted in my last posting, 2016 is an election year. Modern history suggests that opportunities to accomplish major policy objectives in an election year are limited, but we believe this year may be different. We also know that we must approach our work with a greater sense of urgency due to the rapid changes that are coming.
To articulate this, I have decided to borrow a catchy phrase from Sesame Street to describe the AAFP’s advocacy outlook for 2016. So here goes: “The AAFP’s 2016 advocacy agenda is brought to you by the letters M and A.”
MACRA -- On April 16, 2015, President Obama signed into law the Medicare Access and Children’s Health Insurance Program Reauthorization Act (P.L. 114-10). The enactment of MACRA capped a 15-year effort to repeal the flawed sustainable growth rate (SGR) and set in motion reforms that will more appropriately support new delivery systems and establish a path away from fee-for-service. These new delivery and payment models have an opportunity to end decades of de-valuing primary care by appropriately compensating family physicians and financing the functions of an advanced primary care practices.
The major reform provisions of MACRA -- the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs) -- will not be fully implemented until 2019. However, the regulatory framework must be developed during the next 12 to 18 months, meaning 2016 is going to be a busy year for CMS and the AAFP. The Academy outlined many of its views on the major issues in our response to a 2015 CMS request for information (RFI) on MACRA implementation.
I encourage you to familiarize yourself with the implementation timeline. It is important that you and your practice start thinking about how you will transition into one of the two payment pathways established by MACRA. The AAFP will be rolling out extensive content and resources during the next few months and will feature extensive education opportunities for family physicians.
You can access AAFP content on our MACRA resource web page. We also anticipate publishing extensive related content through Family Practice Management.
Meaningful Use -- The meaningful use program continues to be the most disliked regulation in existence and for good reasons. Family physicians have implemented electronic medical records at a significantly greater pace than physicians in other specialties. Family physicians also have demonstrated the value of EMRs in enhancing the quality of care provided to patients.
What continues to be a source of frustration is the complex set of regulations that have been developed and implemented through the meaningful use program. As a result of these frustrations, the AAFP has worked to aggressively reform the meaningful use program and eliminate physicians’ exposure to financial penalties that are associated with the program. I am pleased with the progress made in 2015, but more work needs to be done and we are getting some help from a surprising source.
In late December, Congress passed and the President enacted into law, legislation that will provide a hardship exemption from meaningful use stage 2 requirements for qualifying physicians. CMS has, at the time of this posting, not published the guidelines for how physicians can participate in the hardship program. Once this information is available, the AAFP will use multiple communication platforms to share the details with you to ensure that those who wish to seek the hardship exemption have the necessary information to do so.
On Jan. 12, CMS Acting Administrator Andy Slavitt, in a presentation at the JP Morgan Healthcare Conference, pleasantly surprised (totally shocked) the physician community when he publically stated that the meaningful use program may have “met its goals and served its usefulness,” and should be "replaced with something better."
He essentially announced the coming end of the meaningful use program when he said that the "meaningful use program as it has existed will now be effectively over and replaced with something better.”
Obviously the details matter, but the AAFP is pleased that our advocacy efforts have resulted in positive action on the part of Congress and CMS.
On that same day, the AAFP wrote to Slavitt, outlining a set of recommendations on how CMS should pursue revisions to the program. Among those recommendations, we prioritize the need to accelerate robust interoperability to support continuity of care and care coordination, the elimination of burdensome requirements on practices that detract resources away from patient care, and alignment of the numerous regulations governing patient care.
A is for Administrative Complexity and Alignment
Administrative Complexity -- Last year I wrote a posting on “Whacking the WAC.” The time and energy devoted to the administrative functions of a family medicine practice continues to be daunting if not overwhelming. The most frustrating aspect of this issue is few of the administrative functions required of family physicians have any measurable impact on the quality of care received by patients. Multiple surveys and studies have placed the overall time allotted to administrative functions at 15 percent to 17 percent for most physicians.
This is an astonishing allocation of time both from the perspective of meeting administrative requirements, but also the loss of patient care time that results from these administrative requirements.
The so-called “work after clinic” is a major contributor to physician burnout and, unfortunately, leads many physicians to make career decisions that may not be aligned with their personal and professional goals.
It also contributes to the belief that the intensity of work in primary care is not appropriately compensated by payers. To be blunt, the 15-minute office visit is really a 20-minute visit that is compensated at 15 minutes. This is what is inherently unfair about the system and why we are dedicated to reducing administrative complexity.
Alignment -- One of the greatest frustrations expressed by family physicians is the variation in quality and performance measures used by public and private health care payers. Physicians also express frustrations about the lack of congruency in the definitions and execution of delivery system programs such as the medical home or chronic care management programs. This frustration is completely understandable given that family physicians have such a diverse set of payers.
According to research conducted by the AAFP, 61 percent of family physicians have contractual relationships with seven or more payers, and 38 percent have relationships with 10 or more.
The AAFP places a high priority on this work. We continue efforts to educate and influence the commercial insurance plans through meetings and continuous communications with the leadership of these companies.
We also have a meaningful working relationship with America’s Health Insurance Plans (AHIP), which has allowed us to advance policy recommendations that would achieve some level of alignment between payers. We are optimistic that this work with AHIP will be rewarded through the adoption and implementation of a “core (quality) measure set” for primary care. If this comes to fruition, then family physicians would have a single set of quality measures that would be reported to Medicare and all commercial insurers.
I can assure you that this isn’t a comprehensive list of issues that we will be working on this year. This list does not include many priority issues. However, this is a solid summary of the major opportunities and challenges we see in family medicine. Nothing, and I mean nothing, is more pressing than these four issues. I look forward to engaging with you during the next year, and I remind you that your comments and feedback make our work better and more impactful for you and your practice. So, keep them coming.
Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy. Read author bio »