AAFP to CMS: Time to Slow Administrative Busy Work

Proposed 30-day Network Directory Update Draws Academy Ire

October 08, 2015 12:22 pm News Staff

The AAFP is well aware of the frustration family physicians have with public and private payers who continue to heap administrative work on practices already working overtime to take the best possible care of their patients.

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And so recently, the Academy once again stepped in to shield members from more of the same.

In this instance, the AAFP pushed back when CMS suggested that insurers who participate in Medicare Advantage and health insurance marketplace plans be required to update their respective physician network directories every 30 days.

In a Sept. 28 letter(2 page PDF) to CMS Acting Administrator Andy Slavitt, (then) AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., noted that more than 60 percent of family physicians have contractual relationships with seven or more insurance companies.

"If each of these insurers requested information on network participation and the physician's status on accepting new patients on a 30-day interval, a family physician would receive more than 90 such requests in a year," said Blackwelder.

"We are concerned that the frequency of reporting recommended by CMS will have significant unintended consequences and may actually hinder the collection of accurate information."

In fact, said Blackwelder, it's entirely possible that some overburdened physicians might choose to ignore such requests for information, "therefore making our desire to provide accurate and timely information to patients less achievable."

Blackwelder reminded Slavitt of the AAFP's strong support of CMS' goal to ensure that patients have the information they need about their physicians' plan participation.

In fact, the AAFP has expended considerable effort working with a variety of physician organizations and America's Health Insurance Plans to find solutions agreeable to both consumers and CMS, he noted.

"We believe that such a solution exists and can be implemented in a manner that limits the administrative impact on physicians and their practices," said Blackwelder.

Accordingly, the AAFP strongly urged CMS to implement a 90-day reporting interval.

"Collecting and reporting this important information on a 90-day interval will not jeopardize accuracy of network participation," but would surely relieve physicians' administrative load, said Blackwelder.

"Family physicians are extremely vocal about their frustrations with the increasing level of administrative burden," said Blackwelder, because it conflicts with their ability to take care of their patients.

A more balanced approached could prove to be a more effective one, he concluded.

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