"The goal is to turn data into information and information into insight."
-- Carly Fiorina, former CEO of Hewlett-Packard Co.
Increasingly, data is becoming the most valued and protected commodity in our economy. Businesses have captured and analyzed data for decades. What began as simple revenue and accounting data has exploded into consumer behavior microdata capable of providing predictive data on what you need and when you need it before you even realize it yourself. The volume and depth of data is both exciting and somewhat frightening.
The AAFP, like so many other organizations, relies on data to inform its education, advocacy, and member services activities. We value the direct feedback we get from our members on your activities, attitudes, opinions, needs and challenges. The AAFP, through its Marketing Research Department, conducts numerous surveys and focus groups annually -- all aimed at better understanding family physicians so that the AAFP can better serve you. There are two annual surveys that are foundational to our work: the Member Satisfaction Survey and the Practice Profile Survey.
The AAFP Practice Profile Survey is designed to evaluate the practice of family medicine. What are you doing each day? Who are you working with? Who is paying you? What tools and services are you using in your practice? What are your greatest needs? These and many more questions are included in the survey. The findings provide tremendous insight into the day-to-day lives of family physicians, driving improvements in our advocacy, education and member services.
I want to thank those of you who have responded to an AAFP survey in the past, and I would respectfully request that if you are included in a future sample, please take a few minutes to respond. Your responses strengthen the survey and directly inform our work.
Now, let's take a peek at some of the key findings from the 2017 Practice Profile Survey:
Family medicine continues to encompass a committed and diverse group of professionals. Here is a quick overview of the AAFP membership:
Employed members work for a variety of entities. Eighteen percent are employed by other physicians, 15 percent are government employees, and 49 percent are employed by a hospital or health system.
Physicians reported working an average of 45.5 hours per week. The breakdown reflected that family physicians spent 32 hours in direct patient care, 7 hours on other patient care tasks, 2 hours on prior authorizations and 4 hours on other duties.
This is a decrease from 2012 when family physicians reported working an average of 52 hours per week. Interestingly, the number of hours devoted to direct patient care was about the same, at 32 hours per week.
One item that jumps out at me is how underreported the level of administrative burden may be. We know from other studies and sources that physicians spend a large amount of time after clinical hours working on patient charts via the electronic health record or reporting quality or performance metrics to various payers. This "work after clinic" doesn’t always get reported, but it obviously exists.
Physicians reported an average of 83.1 patient encounters per week. The breakdown showed 74 of the 83 encounters occurred at a physician's office, 5 at a hospital, 2 at a nursing home, 2 via an electronic visit, and just less than 1 house call per week.
As expected, the number of encounters per week has dropped since 2012, when the averages were 92 patient visits per week, including 82 at the office. There also has been a fairly significant drop in the number of encounters at the hospital.
Family physicians continue to have a relatively balanced mix of payers in their practices. In 2017, practices reported that their panel was 41 percent private insurance, 28 percent Medicare, 18 percent Medicaid, and 7 percent uninsured. Since 2012, there has been notable shifts in the payer mix for family physicians, with Medicare and Medicaid comprising a greater percentage of the payer mix and practices reporting decreases in the number of uninsured patients.
In 2012, family physicians reported that their panel was 46 percent private insurance, 24 percent Medicare, 14 percent Medicaid, and 10 percent uninsured. For a more longitudinal look, in 2009, family physicians reported that 52 percent of their panel was covered by private insurance, 24 percent by Medicare, 14 percent by Medicaid, and 11 percent were uninsured.
Participation in the Medicare program among family physicians has remained steady. In 2017, 83 percent of members reported that they accept new Medicare patients in their practice. In 2012, the percentage was 81 percent, and in 2009, it was 78 percent. Acceptance of new Medicaid patients is at a historical high of 69 percent. In 2012, the percentage was 62 percent, and in 2009, it was 58 percent.
The average practice setting, according to the survey, included 25.2 full-time equivalent employees (FTEs). Of those FTEs, practices averaged 6.3 physicians, 10.2 clinical support staff and 5.8 non-clinical support staff. The balance of the FTEs were spread across nurse practitioners, physician assistants and other staff. One interesting development was the increase in the number of nurse practitioners in the practice setting compared to the number of physician assistants. In 2013, approximately 60 percent of practices reported having no NPs. That percentage dropped to 42 percent in 2017. By comparison, the number of practices reporting no PAs in the practice remained stable at roughly 60 percent.
The number of members practicing in a patient-centered medical home continues to grow. Forty-one percent of members are practicing in a recognized PCMH, up from 26 percent in 2012.
The AAFP continues to value and prioritize the medical home. However, from a practice transformation perspective, we are more focused on capabilities and functions of primary care practices. Specifically, we are focused on the five core functions of an advanced primary care practice based on our belief that these functions and capabilities are more indicative of a high-performing practice than third-party validation. Family physicians have embraced these five functions in their practice. In 2017, the following percentage of members reported that they have implemented these functions in their practices:
The MACRA Quality Payment Program continues to be a priority issue for the AAFP and our members. We are devoting substantial resources to ensuring that all family physicians are informed, educated, and positioned to be successful under one of the two QPP payment pathways -- MIPS (Merit-based Incentive Payment System) or Advanced APMs (Alternative Payment Models). The survey results show that we have much work to do.
Forty-eight percent of family physicians reported being "very familiar" or "somewhat familiar" with MACRA, but I am concerned that 26 percent reported that they were "not very familiar" with MACRA, and 19 percent stated that they are "not at all familiar" with it.
Since we are in the initial QPP performance period, we asked family physicians how they are managing MACRA and the two payment pathways in their practice. Twenty one percent of family physicians reported that they would participate in the MIPS pathway indefinitely, 10 percent indicated they were moving into an Advanced APM immediately, and 21 percent stated that they would participate in MIPS for "two to three years" while preparing to move into an Advanced APM. Again, I was deeply troubled by the fact that 45 percent reported that they were undecided on how their practice would manage MACRA.
In closing, I am confident that many of you will dispute some (or all) of these findings, and that's OK. The survey is designed to provide insight and inform. The results are not being presented as hard facts. I do, however, think they illuminate the practice of family medicine and provide valuable perspective on what is happening across the nation in family physicians' practices.
As always, I look forward to your comments.
Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy. Read author bio »