AAFP Congress moves to create political action committee, approves other resolutions

At its October 2005 meeting in Orlando, the AAFP Congress of Delegates approved several key resolutions:

Establishing a PAC

The Congress of Delegates called for the AAFP to establish a federal political action committee (PAC) by June 2005. The recommendation originated from the AAFP Board of Directors, who concluded that a PAC would help the AAFP advocate on behalf of family physicians.

Delegates debated heavily the ethics of creating a PAC and how it will be funded. The AAFP will cover operational costs of $360,000. Donated funds will be used to support political candidates, as determined by the PAC Board of Directors; however, no PAC funds will be spent on political advertising. The AAFP Board will appoint the PAC Board and oversee its activities.

Maintenance of certification

Delegates also approved several resolutions related to the American Board of Family Practice’s new maintenance of certification requirements for family physicians (MC-FP). Because of much confusion and concern surrounding MC-FP, delegates asked the AAFP to collaborate with the ABFP to educate members on “the process and importance” of MC-FP. They also asked the AAFP to urge the ABFP to suspend the MC-FP self-assessment modules “until technical and clinical problems are adequately resolved,” to develop a better beta-testing mechanism “to gather and disseminate evidence of effectiveness,” and to “develop an alternative mechanism for those members who have unreliable access to the Internet.” (For more information on MCFP, look for the FPM cover story in January 2005.)

Payment for administrative services

To address the issue of nonpayment for administrative services (such as completing forms or other paperwork), the AAFP Congress recommended that the AAFP “provide family physicians with information on how to bill and collect for clinical and administrative services not covered by insurance, and advocate with public and private insurers to recognize the value of, and to appropriately pay for, these services.”

Administrative tasks cost practices thousands

Large amounts of money, staff time and physician time are spent each year on wasteful or unnecessarily complicated administrative tasks, according to new research from the Medical Group Management Association’s Group Practice Research Network, comprised of almost 300 group practices.

According to the findings, a group practice with 10 physicians spends more than $247,500 per year on unnecessarily complex or redundant administrative tasks, such as the following:

• $19,444 making phone calls to pharmacies to resolve drug formulary issues,

• $38,761 verifying patient coverage, co-payments and deductibles,

• $9,248 resubmitting denied claims, 73 percent of which are eventually paid,

• $7,618 submitting credentialing applications for physicians,

• $33,800 negotiating and renewing insurance contracts.

The MGMA has proposed a Simplified Payment System Concept (http://www.mgma.com/simplify.cfm), where payers would use one credentialing process, one set of clinical guidelines, one formulary, one set of coding and documentation policies, etc.

“Unnecessary administrative complexity accounts for a large portion of the $1.79 trillion our nation will spend on health care this year,” said William F. Jessee, MD, president and CEO of the MGMA. “We urge all the stakeholders in our system – patients, payers, employers and providers – to face the real cost of this wasteful system and work toward redirecting wasted resources into activities that expand access and improve care for our nation’s citizens.”

What patients want

U.S. adults place more value on physicians’ interpersonal skills than on their training or experience, according to a Harris Interactive poll conducted in September for the Wall Street Journal Online. The most highly rated characteristics were “treats you with dignity and respect” (rated “extremely important” by 85 percent of respondents), “listens carefully to your health care concerns and questions” (84 percent) and “is easy to talk to” (84 percent). Physicians generally met patients’ expectations in these areas. However, the largest gap between what patients want and what they think they get from their physicians involved being “up to date with the latest medical research and medical treatment.” Seventy-eight percent of patients rated this extremely important, while 54 percent said this described their doctor well.

PRACTICE PEARLS from here and there

Make sure patients are ready for the doctor

To ensure that patients are ready for the physician at the start of an exam, develop a rooming checklist for nurses or medical assistants to use. For example, rooming criteria for diabetes patients may include “shoes off.” Such checklists not only increase office efficiency but also aid float or cross-trained personnel when they come in to assist, assuring a standardized preparation for each visit. Download a sample rooming criteria checklist at http://www.ihi.org/IHI/Topics/OfficePractices/Access/Tools/RoomingCriteriaExample.htm.

Medicare changes for 2005

Physicians’ Medicare reimbursement rates will increase 1.5 percent in 2005, as mandated by last year’s Medicare reform law. Without the law, physician payments would have decreased 3.7 percent in 2005, the result of what many believe is a flawed payment formula. Rate decreases are expected in 2006 and beyond if Congress does not act to correct the sustainable growth rate formula, which was enacted by the Balanced Budget Act of 1997 to limit growth in Medicare spending on physician services. In 2005, many physicians will also be eligible for a 5 percent bonus for working in underserved areas of the country. Medicare will also begin covering an annual preventive medicine exam in 2005, as well as screenings for heart disease and diabetes.

Withholding pay for medical errors

HealthPartners, one of the largest health care insurers in Minnesota, has announced it will soon begin withholding reimbursements to hospitals for cases involving serious medical errors, or “never events,” such as wrong-site surgery. Hospitals that contract with HealthPartners will be required to report such medical errors within 10 days of discovery. Because these errors are rare, the policy is not expected to reduce company costs significantly. Instead, the company says, it is intended to increase accountability and send a message that errors shouldn’t be paid for.

R_x company encourages use of generics

Novartis, which produces brand-name pharmaceuticals, recently issued a memo asking its employees to use more generic and over-the-counter medications to help control escalating costs, the Oct. 15 Newark, N.J., Star-Ledger reports. The memo indicated that company employees were “significantly below the norm” in their use of generic drugs and other cost-effective treatments. Novartis employees receive medications manufactured by the company – and by generic pharmaceutical company Sandoz, a Novartis subsidiary - at no cost.

E/M clinical examples scrapped

After conducting a pilot study to assess whether clinical vignettes should replace the 1995 and 1997 E/M documentation guidelines, the AMA’s CPT Editorial Panel has officially scrapped the plan. The panel concluded that, despite years of work by the AMA and 11 specialty societies, the new system was no better than the 1995 or 1997 guidelines. Doctors participating in the project were able to code services correctly less than half the time when using the clinical examples.

Bill would prohibit extra fees

A measure recently endorsed by a New Jersey Senate committee would, if passed, prohibit physicians in the state from charging HMO patients any fees beyond their co-payments or deductible amounts. This would include fees for e-mails, phone consultations and requests for prescription refills. Fines for those seeking to collect the fees would be $500 for a first offense, $1,000 for a second, and $2,500 for a third. The measure awaits action in the New Jersey Senate.