2015: Year in Review

AAFP Helps FPs Weather Payment, Practice Management Issues

January 04, 2016 01:29 pm Sheri Porter

It's hard to believe that with a flip of the calendar page, 2016 has arrived. As we bid adieu to 2015 and launch into a brand new year, it's time for a look back at some of the most significant practice management issues that kept the AAFP and its members busy during the past 12 months.

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The Academy spent a vast amount of time and energy in 2015 fighting to ensure that family physician get the pay they deserve -- now and in the future -- for the work they do.

From SGR to MIPS, APMs

Family medicine celebrated a huge victory in April when Congress overwhelmingly repealed the flawed Medicare sustainable growth rate (SGR). The AAFP had fought tirelessly for more than a decade to end the SGR, which at the time of its dissolution had racked up $170 billion in costs related to 17 short-term fixes meant to avoid disastrous cuts to physician payments.

The Academy is now engaged in a herculean effort to help CMS understand exactly what family physicians want and need from a new value-based payment system currently under construction to replace SGR.

A team of AAFP staffers and family physician members worked together throughout the fall to compile feedback for CMS in answer to the agency's request for information on how to best move forward with implementation of the Merit-based Incentive Payment System (MIPS) and promotion of alternative payment models (APMs) as part of the larger Medicare Access and CHIP Reauthorization Act (MACRA).

The Academy's input was, and will continue to be, crucial because MACRA will impact how Medicare will pay physicians beginning in 2019, and many of those details have yet to be determined by the HHS secretary.

Getting family physicians geared up for value-based payment after they've been operating in a fee-for-service culture for decades is an immense job that requires informed decisions. That's why the Academy partnered with private health insurer Humana on a survey to determine family physicians' level of readiness in implementing new payment models.

Survey findings from 626 participants showed that one in every three family physicians was already pursuing value-based payment. Importantly, the AAFP shared that statistic and other survey findings(2 page PDF) at a briefing held on Dec. 1 in Washington for congressional staff members and other interested stakeholders.

2016 Medicare Physician Fee Schedule

In what has become an annual fall task, the AAFP once again dug through CMS' proposed 2016 Medicare physician fee schedule looking for ways to tilt it in favor of family physicians.

In a pointed letter to CMS Acting Administrator Andy Slavitt,(28 page PDF) the AAFP called for the agency's ongoing attention to activities related to MIPS, APMs and the value-based payment modifier.

And when the final 2016 fee schedule was released in November, the AAFP wasted no time blasting CMS for breaking its promise of a positive primary care physician update in 2016.

"I am very disappointed with CMS, specifically, and their inability to identify 1 percent in overvalued CPT codes," AAFP President Wanda Filer, M.D., M.B.A., of York, Pa., told AAFP News at the time.

"Family physicians have been undervalued for way too long," she added. "The very physicians who are doing the heavy lifting when it comes to caring for Americans deserve much better."

CPT Codes

In America's health care system, of course, payment revolves around CPT codes; hence the AAFP's rapt attention to this important topic in 2015. On the next-to-last day of 2014, the Academy joined 10 other medical specialty organizations in urging CMS to recognize and make separate payment for two new CPT codes -- 99497 and 99498 -- that describe complex advance care planning.

The issue was left unresolved, however, and so the Academy, along with dozens of other organizations, prodded HHS to recognize existing CPT codes and thereby allow physicians to bill separately for such services.

"Programs like the Physician Quality Reporting System already ask physicians to report on whether or not they did advance care planning with patients," said the organizations in a May letter(3 page PDF) to HHS Secretary Sylvia Burwell.

The AAFP also kept the pressure on CMS to allow physicians to use the chronic care management code in connection with Medicare Advantage plans.

[Doctor handshake at male patient's bedside]

The Academy deftly tackled another lurking payment issue in July when it made a persuasive case to some of America's biggest private health insurers that they should pay primary care physicians for hospital consultations.

"We believe that there is value in paying primary care physicians to see their patients in a hospital setting and that there is some evidence to suggest that doing so has benefits in terms of both improved outcomes and cost savings to the health system," said the AAFP in a July letter to each of the seven companies.

In a similar letter sent to CMS in September, (then) AAFP Board Chair Reid Blackwelder, M.D., of Kingsport, Tenn., urged the agency and private payers to "review and revise" their coverage policies to recognize primary care physicians as specialists when acting in a consulting role in the care of a hospitalized patient.

EHRs, Meaningful Use

Family physicians may remember that electronic health records (EHRs) stormed onto the health care scene -- and into their offices -- more than decade ago. As time passed, the furor surrounding their advent largely died down as physicians began adjusting to the new technology.

But in 2015, FPs' frustration at the continuing difficulties posed by the systems exploded, and they unleashed on both CMS and the AAFP their increasing discontent with the burdensome Medicare and Medicaid EHR Incentive Programs and their accompanying meaningful use (MU) regulations.

Repeatedly throughout the year, the AAFP called on CMS to push back MU deadlines and to make a confusing set of rules easier for physicians to understand.

In May, the AAFP responded to a proposed rule that would modify MU stage two requirements for 2015 through 2017.

Referring to the "all-or-nothing" nature of the MU program in which physicians must meet all requirements or face a penalty, the AAFP said, "We sincerely hope CMS improves this characteristic of the program rather than increasing the number of required measures."

The letter also noted that MU auditors were "causing undue hardship for family physicians with unreasonable and burdensome documentation requests."

The auditing issue popped up again in July when the AAFP demanded straight answers from CMS after hearing scathing reports from family physicians who'd been on the receiving end of an audit.

In December, AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., declared meaningful use "a program in crisis" and cited a 27 percent decrease in physician satisfaction with their EHRs since the launch of the MU program.

"EHRs should be a tool for success in a physician's practice, not an obstacle to overcome," said Wergin in a Dec. 2 letter(3 page PDF) to HHS Secretary Burwell.

Finally, there was good news on the MU front on Dec. 18, when the U.S. House and Senate approved legislation that included a provision granting CMS the authority to expedite applications for hardship exemptions from MU stage two requirements.

Physicians seeking an exemption must apply before March 15; details on how to do so will be released soon.


Physicians across the country spent much of 2015 preparing for the Oct. 1 implementation of the ICD-10 code set for outpatient diagnostic coding. At the same time, the AAFP worked to create resources to help FPs in their preparations.

The AAFP also fought to shield family physicians from any unintended ICD-10 fallout. In a June 16 letter to CMS,(1 page PDF) for example, the AAFP demanded assurances that Medicare administrative contractors (MACs) were prepared to handle the onslaught of new diagnosis codes and that "no family physician would be penalized financially by a MAC's failure to do so."

A second letter(1 page PDF) went out to Secretary Burwell the very next day in which Blackwelder described the implementation of ICD-10 as a "significant, large and technically challenging operation," and he called on CMS to refrain for three years from auditing or seeking recoupment on any claim containing an error attributable to the ICD-10 transition.

In July, CMS announced a one-year grace period to help physicians ease into the ICD-10 transition.

And then, America's medical community breathed a collective sigh of relief when Oct. 1 came and went without much hoopla. To date, the transition from some 13,000 diagnostic codes to more than 68,000 seems to have gone smoothly, but AAFP News will inform family physicians of any glitches that pop up in 2016.

After a session on how to start a direct primary care practice from scratch, Mark Turshen, M.D., left, asks presenter Joseph Sheppard, D.O., about how to best increase patient panel size.

Direct Primary Care

Family physician interest in the direct primary care (DPC) model -- in which physicians charge patients a flat monthly or annual fee in exchange for a wide array of health care services -- soared to new levels in 2015.

In July, the AAFP hosted the Midwest's first DPC Summit. The sold-out event drew 317 attendees from 45 states.

For three days, attendees immersed themselves in sessions led by physicians already enjoying their DPC practices and eager to share their stories -- and their know-how about the model -- with colleagues from around the country.

Summit participant Jill Mahoney, M.D., of Scarborough, Maine, shared her excitement about leaving her traditional practice behind after 10 years on the fee-for-service treadmill.

"I'm done spending all my time on paperwork and not with patients," Mahoney told AAFP News. "I'm excited about being a doctor again."

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