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Tuesday May 26, 2015

ICD-10 Is Inevitable. Be Ready.

As we approach the official start of summer, I’d like to provide updates on some important issues that I believe are likely of interest to each of you. On a personal note, I’m encouraged to see -- with the baseball season entering its third month -- the Washington Nationals are starting to play as well as the “experts” predicted. The long, hot days of summer are where pennants are won and lost to be sure, but I’m encouraged that our nation’s baseball team is currently performing better than Congress, although that is a pretty low bar.

As always, I appreciate your feedback, thoughts, suggestions and occasional criticism of our advocacy work. We here at the AAFP want to make sure that we are representing you in the most effective manner possible, and I believe the interaction generated through this blog, as well as other AAFP vehicles, is critical to our ability to do so. So, keep those comments coming.

As of today, you have 127 days to prepare your practice and staff for ICD-10. With the Oct. 1 compliance date rapidly approaching, I thought it advisable to remind you about the AAFP resources available to assist you and your practice with the transition from ICD-9 to ICD-10. These resources include education materials, tutorials and coding flashcards that cross-walk the top 100 ICD-9 frequently used codes in family medicine practices to the more than 800 corresponding ICD-10 codes that will replace them.

We also continue to encourage all members to conduct end-to-end testing to ensure that you are prepared to make the transition. We are emphasizing testing with your billing clearinghouses, as well as with your payers. These clearinghouses created a tremendous bottleneck during the Form 5010 transition, so to avoid this problem; everyone needs to do their part to ensure this will not reoccur during the ICD-10 transition.

The AAFP continues to communicate with CMS on this issue, and we are expressing our desire to see CMS establish some form of a contingency plan -- especially for solo and small practices -- to ensure claims are paid in a timely manner in the event the conversion from ICD-9 to ICD-10 does not go as predicted.

Annual Wellness Visit
On April 30, the AAFP wrote to CMS expressing concerns with the emerging prevalence of commercial entities offering annual wellness visits (AWVs) to Medicare beneficiaries. In the letter, the AAFP asserted that “the AWV is a tool designed to encourage Medicare patients to engage with their primary care physicians on an annual basis for prevention and detection of illness and we are concerned that there are commercial entities that are subverting that benefit and may be misleading patients.”

The AWV was established as part of the Patient Protection and Affordable Care Act (ACA) and became part of the Medicare benefit package on Jan. 1, 2011. The AAFP actively supported the AWV as part of the ACA, and while we’ve expressed some serious concerns with the complexity of the documentation associated with the service, we continue to see this as a high-value service that connects family physicians with their patients. In the past year we’ve become increasingly concerned that commercial entities that have no desire or intention of providing continuous or comprehensive care have begun promoting their services directly to Medicare beneficiaries.

Unfortunately, it’s come to the AAFP’s attention that patients may be precluded from the benefits of the AWV provided by their family physicians due to services provided by a commercial entity. We see no commitment on the part of these companies to establish a relationship with the patient and it’s clear that they have no intention of caring for the patient after the AWV is provided. This practice has also drawn the attention of the Federal Trade Commission, which shares our concerns that the direct-to-consumer marketing of these commercial entities may contain false or misleading representations or intentional omission of key facts.

The AAFP met with CMS on this issue earlier this month, and we are working closely with key federal decision makers on a solution to this issue. We will keep you posted on our progress.

Give Me More Family Medicine
The Annals of Family Medicine recently published an article highlighting research done by the Robert Graham Center(www.annfammed.org) and building on previous research demonstrating the relationship* between primary care, better health outcomes, and lower overall per capita spending on health care.

The authors conclude that, “Increasing family physician comprehensiveness of care, especially as measured by claims measures, is associated with decreasing Medicare costs and hospitalizations. Payment and practice policies that enhance primary care comprehensiveness may help ‘bend the cost curve.’”

This article makes an important contribution to the growing body of literature and demonstrates the value proposition of primary care broadly and family medicine specifically. To view other work produced by the Graham Center please visit their newly redesigned webpage.

* I would have gone with a correlation/causation argument here, but my good friend and co-worker Julie Wood, M.D., would have a field day with my novice mistake.

End-of-Life Care
The AAFP recently joined more than 60 organizations in urging CMS to value, and start paying for, Advanced Care Planning services through two previously established codes. In a May 12 letter, the AAFP and others urged the inclusion of CPT codes 99497 and 99498 in the 2016 Medicare Physician Fee Schedule.

In addition, the AAFP has recently partnered with the Pew Charitable Trust as a collaborator in its Improving End-of-Life Care(www.pewtrusts.org) initiative. This activity brings together several groups who share a common interest in advancing public policy that promotes access to advanced care planning and palliative care.

I anticipate that this issue will become a more prominent part of our national health policy dialogue in the months and years to come. If you are interested in this topic, American Family Physician offers a great collection of resources.

Family Medicine Congressional Conference
The AAFP recently hosted the Family Medicine Congressional Conference (FMCC) in Washington, D.C. This event brings together family physicians, residents and medical students to advocate on behalf of family medicine. This year, more than 200 participants heard presentations from three members of Congress, a senior administration official, six Congressional staffers, and national experts on issues of importance to family medicine. Additionally, participants visited the offices of 160 representatives and 83 Senators to advocate for reforms to our nation’s graduate medical education system.

This event is informative, fun and important to the Academy's success in Washington. I urge you to join us at the 2016 FMCC, which will be held April 18-19 in D.C.

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Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.