Family General Practice trends and changes in the new Health Care Reform era...

Family General Practitioners are going to be in high demand; The American Academy of Family Practitioners has weighed in on the subject:

In addition to Employer, retailer, large Manufacturer an Other employer worksite Clinics, the feeling is that family practice Clinics are going to start to appear in ‘unconventional’ but intuitive places. The Medical Malpractice Carriers and our understanding of ‘usual and customary’ places of delivering healthcare will change.

The Feeling is, that as long as there is proper equipment, protocol and trained personnel, from M.D.’s and R.N.’s to appropriate PHI storage and documentation, healthcare can happen anywhere.  Anywhere is starting to increasingly sound like ‘work place’ health clinics.

The Doctors’ Insurance Agency is working with family physicians that are setting up practices at industrial employers, drug stores and even malls, call us to learn how malpractice underwrites are considering this risk, the importance of licensure, venue review, proper equipment inventory stock and trained personnel on site to manage the inevitable triage during emergency patient encounters.  We work closely with our Patient Safety Department to develop and discover methods Of risk reduction and safe practices, best practices in clinical ‘on site’ settings.

How Health Care Reform Will Affect Family Physicians, Family Practice Magazine weighs in with this:

On March 23, with the strokes of 22 pens, President Obama signed into law the Patient Protection and Affordable Care Act. This sprawling health care reform bill has many unknowns – chief among them, will it really reduce the deficit by $143 billion over 10 years, as the Congressional Budget Office estimated? But here's what we do know: The bill will expand health insurance to an estimated 32 million Americans and provide important consumer protections, such as an end to pre-existing condition exclusions. It also includes a variety of less-talked-about measures designed to improve the quality and cost-effectiveness of health care.

To find out how these measures will affect family physicians, FPM interviewed Kevin Burke, a Washington expert and director of government relations for the AAFP  

FPM: What aspects of the bill are likely to have the biggest effects on family physicians?

Burke: There are two provisions related to payment that are important, not simply for the payment differential they provide but also because they send a pretty clear signal that ripples throughout the bill that primary care deserves a lot more attention than it's gotten in the past. Beginning Jan. 1, 2011, primary care physicians – defined as those in family medicine, internal medicine, geriatric medicine and pediatric medicine – will get a 10-percent bonus for Medicare services. To qualify for the bonus, 60 percent of their Medicare charges must be for primary care services as defined by evaluation and management (E/M) codes for office visits, nursing home visits and home visits.

Our view is that the 60-percent threshold is probably too high. The Graham Center recently found that at a threshold of 60 percent, only 59 percent of family physicians would qualify for this bonus. If the threshold were lowered to 50 percent, then 69 percent of family physicians would qualify. The threshold has a particularly negative effect on rural primary care physicians because they're the ones who, by virtue of the fact that there are not a lot of specialist physicians in rural areas, end up providing more procedures to their patients. This can skew their ratio of primary care to total services and disqualify them for the bonus.

We're also concerned that this is just a five-year program, scheduled to end Jan. 1, 2016, and that it applies only to payments for primary care services, not to all Medicare services that primary care physicians provide. So we still have some legislative changes to request and hope to be able to convince Congress to extend the bonus permanently. Nonetheless it makes the point, however imperfectly, that the physician payment mechanism we have right now undervalues primary care and needs to be fixed.

The second payment program in the bill is also a time-limited one. In 2013 and 2014, all Medicaid payments for primary care services will be increased so that they are at least equal to Medicare payments. This will have a variable effect on family physicians. In some states, like North Carolina, Medicaid already pays 95 percent of Medicare, but in states like California where the discrepancy is much larger, family physicians that care for Medicaid patients will, for two years, see significantly better payments. And again, it's just for primary care providers and for primary care services.

FPM: The bill creates an Independent Payment Advisory Board starting in 2014 that will recommend Medicare spending reductions to Congress. Should physicians be concerned about this?

Burke: This is one of the most significant provisions in the bill aimed at trying to reduce the cost of health care. There is considerable concern in the physician community that the burden would be borne mostly by physicians, whose payments would be cut, especially in the early years, because hospitals and hospice programs are exempt from the actions of this board until 2020. You can't control health care costs without controlling the costs of hospitals – one of the major players in the health care delivery system.

FPM: A number of measures in the bill emphasize quality measurement and paying for value instead of volume, which worries physicians who have had a negative experience with Medicare's Physician Quality Reporting Initiative. What would you say to those physicians?

Burke: For the moment, these are just pilot programs in the legislation, but I do think value-based payment is inevitable and could actually help primary care physicians in the long run, because they have stronger relationships with their patients. I don't think physicians will ever be penalized because patients don't lose weight, for example. Instead, there is simply going to be a lot more of, “Have you counseled your patient to do X, Y and Z?” I think patients will be held more accountable by their health insurance companies as well.

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