• The Backbone of American Health Care: Serving Small Practice Family Physicians

    One of the most common questions asked on this blog, and other AAFP mediums is, “what are you doing for small practices?” The answer is “a lot.” 

    The AAFP is committed to providing services and products to all family physicians, and the Academy strives to be your first and most trusted source for information and resources. Family medicine is a large and diverse discipline, and our goal is to meet your professional and practice needs, regardless of your practice size, type, location or employment status. Our members are all equally important to the AAFP, and we want to assist you in achieving professional success, so you can concentrate on delivering high quality care to the millions of patients you care for collectively.

    The solo and small physician practice remains the bedrock of our nation’s health care system. Although much has changed, the presence of a family physician in communities large and small has remained consistent. Today, more than 70 percent of family physicians practice in groups of five or less. Although some of these physicians may be employed or integrated into larger delivery systems, they remain a solo or small group practice, striving to provide the highest quality of care to their patients.  

    Although change is inevitable, the volume and pace of change can be overwhelming. In the past decade, family physicians have seen the implementation of the Physician Quality Reporting System (PQRS) and numerous quality reporting programs operated by private payers; the establishment of meaningful use criteria that govern the way in which you must use your electronic health records to earn an incentive and avoid a penalty from Medicare;an explosion in prior authorization and appropriate use criteria programs; new requirements on physician authorization for diabetic supplies and durable medical equipment and more.  

    You have been asked to do this at the same time that you have seen revenue decrease as a result of a flawed Medicare physician payment formula and continued squeezes on payment by Medicaid and insurers. Each of you know the challenges of meeting these demands, suggestions, and mandates better than I. But I think it is important for you to know that we hear you, and the Academy is working hard to help.

    Recognizing the importance of solo and small group physicians to our health care system and the numerous challenges these physicians face, the AAFP formed the Independent, Solo, Small Group Practice Member Interest Group. This group is an important voice for solo and small practices, providing insights and feedback to the AAFP on practice and advocacy issues. If you are a solo or small group practice family physician, or simply someone who supports the practice model, I encourage you to participate in this important group. Not only can you provide input to the AAFP but you can also share best practices with your colleagues who share similar issues and concerns.

    In addition to the member interest group and our advocacy in Washington, D.C., and state capitols, the AAFP has amassed volumes of resources for solo and small group practices. You can find these resources on the AAFP’s practice management webpage. I  also encourage you to utilize resources from Family Practice Management (FPM). These resources provide information and tools related to many of the issues facing your practice.  

    I would like to highlight resources the Academy has developed in five key areas: PQRS, meaningful use, practice management, ICD-10 and practice transformation.  

    Physician Quality Reporting System
    There are two primary incentive/penalty programs for family physicians participating in Medicare -- PQRS and meaningful use. PQRS includes a bonus payment for eligible professionals who report data on quality measures for covered services provided to Medicare Part B fee-for-service beneficiaries in 2014. However, the program also implements penalties starting in 2015 for performance year 2013; potential penalties related to the 2014 performance year are effective in 2016. Time is running out to report 2014 PQRS data. You have until 5 p.m. EST on Feb. 26 to submit your 2014 data via the PQRSWizard referenced below. Doing so will help you earn a 0.5 percent bonus for 2014 and avoid a 2 percent penalty in 2016.

    The AAFP has several resources available. The Academy also offers at a reasonable price a cloud-based clinical registry program, PQRSWizard, to assist small practices in meeting PQRS requirements.

    Meaningful Use
    The Medicare Electronic Health Record (EHR) Incentive Program provides incentive payments to eligible professionals who demonstrate meaningful use of certified EHR technology. The cumulative payment amount depends on the year in which you began participating in the program. However, penalties will start this year for physicians who do not demonstrate meaningful use in 2015. Compliance with this regulation is one of the top concerns raised by solo and small group physicians.

    Although the AAFP is working tirelessly to change the regulation to make it more achievable and less onerous, we recognize that you need assistance in meeting the requirements of meaningful use. The AAFP has compiled a menu of services and products aimed at assisting your efforts to avoid the penalties.

    The PCMH Planner has an excellent module aimed at achieving meaningful use. For less than $100, you can receive top-shelf guidance on meaningful use 1 and 2, as well as a step-by-step guide to practice transformation.

    Practice Management
    One of the most important objectives for any practice, but especially small practices, is establishing predictable revenue. Although the most important step to achieving this goal is the elimination of the flawed Medicare payment formula and the sustainable growth rate, there are practice management resources that can help. The AAFP has developed the Five Key Financial Metrics online education modules to assist you in evaluating and establishing sound business practices for accounts receivable, accounts receivable greater than 100 days, adjusted collection rate, denial rate and average reimbursement rate. These online tools summarize steps you can take to improve the financial health of your practice. 

    FPM toolbox also is a tremendous resource for your practice. FPM has articles and tools on a variety of topics, including billing, collections, claims processing, financial management, coding and documentation, staffing and many other important topics.

    Compliance with the upcoming ICD-10 requirement is a concern for all physicians, especially solo and small practices. The Academy supported delaying implementation of these codes, but we recognize the need to provide resources because the transition will become mandatory Oct. 1. The AAFP has several resources designed to provide guidance on this important and complex issue. Our ICD-10 resource page features free information and low-cost products and services to assist your practice in the transition to ICD-10. In addition, FPM has published 11 detailed articles about how to code with ICD-10.

    Practice Transformation
    Practice transformation and process improvement is another area where small practice physicians often feel overwhelmed. To assist practices, the Academy has developed a variety of services and products to help. Whether you are interested in becoming a patient-centered medical home, joining an accountable care organization, or transforming your practice into a direct primary care practice, the AAFP has resources to assist you in your practice transformation goals. Our objective is to provide you information and tools that allow you to move at a pace that is most suitable for you and your practice.

    I want to thank those who remind me and the AAFP of the unique needs of solo and small group practices. Your messages drive innovation and motivate our team to identify, create, and distribute products and services that enable you to be successful in your practice -- no matter how big or small. I hope you now have a better understanding of the products, services, and resources we have that are designed to assist solo and small practices. Our staff has worked hard to make certain that we are meeting your unique needs. However, if there are other resources and tools needed, please let us know. We welcome your insights and appreciate your recommendations.


    Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.  Read author bio »


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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.