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Eligible Clinicians may have difficulty finding the time and resources to fully participate in the 2018 MIPS reporting year – especially if you are part of a small practice. CMS has made 2018 another “Transition Year” for the new Quality Payment Program, meaning, they are still allowing different participation options to satisfy reporting requirements to avoid the 5% penalty. Click here to read more.

The FAFP submitted comments on Monday, September 10, regarding the CMS 2019 Proposed Medicare Fee Schedule noting the administrative simplification efforts are logical but the payment adjustments are flawed. Encouraging CMS to work closely with organized medicine as a whole, particularly the likes of the AAFP which submitted an 80 page response and the FMA, the FAFP leadership is hopeful that the collective comments and concerns from all stakeholders will be taken very seriously by CMS Administrator Seema Verma and her staff. More information will be provided as available considering the final rule will be published in November.

A Patient-Centered Medical Home (or PCMH) is not just a place; it’s so much more. It’s a comprehensive model in which a patient’s needs are coordinated through their primary care physician who works with the patient, and their caregivers, to obtain the best possible health outcomes. Cooper Family Medical (CFM) in Bradenton, FL, recently attained PCMH recognition. The result: enhanced reimbursement, better patient access and care coordination, improved provider and patient satisfaction, and stronger outcomes. According to FAFP member and CFM provider James Pineno, MD, “We were approached by our local Florida Blue Network Manager who said, ‘Your practice is already doing 99% of what is necessary to become a Medical Home. Why don’t you get the recognition?’“ Financial Incentives CFM enrolled in their commercial insurance payer's PCMH Program, which provided funding to help with the costs of attaining PCMH recognition. Now, with recognition in hand, CFM receives significantly enhanced reimbursement from their payer. As a benefit of membership, Dr. Pineno and CFM also received a rebate from FAFP to help offset education and consulting assistance, which they attained through The Center for the Advancement of Health IT (AHIT). In October 2017, Dr. Pineno and his team achieved Medical Home recognition under NCQA.1 Additional financial incentives are also available for qualifying practices through Medicaid and Medicare. If a practice sees Medicaid patients, eligible primary care providers who are PCMH recognized can participate in the Agency for Health Care Administration’s (AHCA’s) Managed Medical Assistance Physician Incentive Program (MPIP)2 to receive the Medicare reimbursement rate for Medicaid encounters. In many cases, PCMH providers who participate in MPIP can double their reimbursement rate on qualifying encounters. Medicare does not provide enhanced reimbursement just for being a Medical Home like the Medicaid plans do, however under the Merit-based Incentive Payment System (MIPS) there are four categories on which practices are scored. One of those categories, “Improvement Activities”, requires practices to submit proof they are performing a selection of predetermined activities to improve the practice. According to Cortnie Fricot, Practice Advisor for AHIT, “If your practice is recognized as a Medical Home, you can earn full credit for this category without having to submit any of the activities from the list. Earning full credit can result in enhanced scoring and reimbursement.” A Medical Home practice can also leverage their recognition with other payers. Strong care indicators, improved health outcomes, and demonstrative reduced expenses arm a practice with tools to negotiate favorable payer contracts. “Certainly, the financial benefit to achieving recognition is valued,” says Dr. Pineno. “It helps to defray the costs associated with delivering a high level of care, and offsets some of the reduced reimbursements we've all dealt with.” Improved Access, Care Coordination, and Outcomes According to Dr. Pineno, “One of the objectives of PCMH is to provide patients with greater access to us, their primary physicians, as well as specialists on their 'care team.' Our relationships with our partners in the medical community allow our patients enhanced access, less waiting, and ultimately better outcomes. Patients appreciate the fact that we have nearly instantaneous access to results of all interventions,” he says. “Our patients have developed confidence in all our staff to have answers to their questions, or direct them appropriately to those staff members who will have the answers. Medical Homes also offer extended hours, which give patients who work and struggle to find time for visits, greater access, and therefore, no excuses,” he says. Embracing Medical Home Transformation While CFM continues to build their specialist ‘partners’, they plan to focus on greater inclusion of patient values and cultures when helping them choose the right course for their patient’s care. “We will continue to stress the importance of having their families as core members of the team and ensure that we are keeping those family members informed of changes in the patient’s health,” says Dr. Pineno. Enhanced Practice Marketing If a practice is in an area where there are not many other Medical Home providers, this gives them a competitive marketing advantage. Patient engagement and satisfaction tends to be higher in Medical Home practices.3,4 It also helps when recruiting providers who can add Medical Home experience to their credentials. “We’ve been embracing the Medical Home concept for years and have consistently been voted the ‘People’s Choice Award Winner for Favorite Family Doctors’ in our area for the 10th consecutive year!” says Dr. Pineno. Critical Factors for Success According to CFM’s Practice Administrator Bonnie Rossi, “The MOST critical factor for our success was 'buy in' from all providers and staff, all of whom recognized the benefit to our patients, and who had been indoctrinated to Meaningful Use for the previous 5 years, and understood the scope of the project, and their individual roles in its inevitable success,” she says. “Equally important was our partnership with The Center for the Advancement of Health IT (AHIT) in guiding us through the tedious (and often confusing) recognition process. Without AHIT, we would not have been successful. Their ability to interpret the guidelines into a language that made sense was invaluable. AHIT had previously guided us through Meaningful Use and we had total confidence in their ability to do the same for the PCMH recognition.” Considering Becoming a Medical Home? Rossi advises, “It’s tedious. Be sure to have as many employees dedicated to the project as is feasible and plan weekly meetings to keep abreast of the progress or any issues that arise. The process of working toward a Medical Home is by far the greatest ‘team building’ experience within a practice. You will engage every member of your staff in some aspect of the patient’s care – whether it’s your scheduling/call center who will focus on the importance of access to the providers, or your Medical Assistances/Nursing staff’s morning ‘huddle’ to plan their day with patients and offer any insight to specific patient needs. Everyone has a role in assuring the patients you will see that day will experience an appointment that answers questions, addresses concerns, and promotes greater access to community partners/coordinated care that ultimately moves patients to the best health possible. Your patients may even lose their fear of that ‘dreaded doctor visit’.” Dr. Pineno recommends that practices considering PCMH get help from resources that are available and take advantage of the many financial incentives that can help offset the cost. “The FAFP PCMH Incentive Program can help to defray the costs of instituting PCMH into a practice and makes the entire process far more palatable,” he says. “The goal is to deliver the best possible care and experience to all patients – a sentiment that is synonymous with FAFP’s ideology.” For more information or to apply for the FAFP’s PCMH Incentive Program, which provides a $3,000 rebate for PCMH assistance, contact Jennifer Young at FAFP at jyoung@fafp.org or (904) 726-0944. References 1 For more information on NCQA’s PCMH recognition program please visit: http://www.ncqa.org/programs/recognition/practices/patient-centered-medical-home-pcmh 2 For more information on the Agency for Health Care Administration’s (AHCA’s) Managed Medical Assistance Physician Incentive Program please visit: http://ahca.myflorida.com/medicaid/statewide_mc/qualified_providers_2017-18.shtml 3 Reid Robert J, Coleman Katie, Johnson Eric A, et al. “The Group Health Medical Home At Year Two: Cost Savings, Higher Patient Satisfaction, And Less Burnout For Providers.” Health Affairs. 2010; 29(5). Available from: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2010.0158 4 Nelson Karin M., Helfrich Christian, et al. “Implementation of the Patient-Centered Medical Home in the Veterans Health Administration Associations With Patient Satisfaction, Quality of Care, Staff Burnout, and Hospital and Emergency Department Use.” JAMA. 2014; 174(8): 1350-1358. Available from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1881931

In response to the moderately severe influenza season and the webinar held on February 9th, 2018, by The Florida Department of Health’s Bureau of Preparedness and Response, Bureau of Epidemiology and Bureau of Public Health Pharmacy a Frequently Asked Questions document has been created for Physicians and Clinicians. Additionally, the Department has placed information from the webinar and influenza guidance documents on our website at the following address: http://www.floridahealth.gov/diseases-and-cond…/…/index.html If you have additional questions that you would like to see addressed in this document, please direct those to StateESF8.Planning@flhealth.gov. We will provide updates as new information becomes available.

Delegates to the AAFP's 2017 National Conference of Constituency Leaders adopted a resolution that asked the Academy to "further prevent the restraint of trade of family physicians by providing a sample legal opinion in favor of family physicians practicing within emergency departments.” In response, the AAFP commissioned law firm Seigfried Bingham to review the applicable law to "determine the extent to which hospitals and physicians may be liable for the denial of medical staff membership or privileges to perform specific procedures based on factors other than demonstrated experience, training and competencies of the physician in question." The legal opinion -- which presents an objective, evidence-based position on privileging -- is intended to provide support for members who find themselves in challenging situations with hospital administrators or others in decision-making positions, and it should not be considered legal advice. More information can be found in the AAFP News article published on the AAFP website. Updated resources on hospital credentialing and privileges are also available.

The following Hassle Factor Form may be completed in order to report insurance administrative and claims processing concerns experienced in your practice. This information is confidential and assists the Florida Academy of Family Physicians (FAFP) in identifying common areas of concern and in facilitating a dialogue with payers. Please provide as much detailed information as possible, such as de-identified documents that support the grievance (e.g. no patient specific information). By collecting data on issues Family Physicians have with third party payers, the FAFP will be better able to identify common areas of concern and facilitate dialogue with payers. Please complete one form per carrier issue. >> Proceed to the FAFP Hassle Factor Form Should you require additional assistance on a particular coding or health plan coverage issue, please contact Jennifer Young, Director of Membership and Practice Enhancement Services at jyoung@fafp.org.

Click below to view a new, free online educational module relating to interprofessional collaboration between physicians and attorneys on behalf of their older patients/clients. The case vignettes and written materials in this module have been produced by the Florida State University Center for Innovative Collaboration in Medicine and Law under a grant from the Retirement Research Foundation. This module is suitable both for individual self-study by physicians and attorneys and by professional organizations as the foundation for live continuing education programs. The module, including written materials, may be accessed by clicking here.

Safe Opiate Prescribing: A Review of the CDC Guidelines Webinar Join FAFP on Thursday, November 16, 2017, from 12:00 p.m. – 1:00 p.m. ET for a FREE webinar on Safe Opiate Prescribing: A Review of the CDC Guidelines by Dr. David Koo. During this one-hour webinar, the following learning objectives will be addressed: Determining when to initiate or continue opioids for chronic pain; Determining the appropriate opioid selection, dosage, duration, follow-up and discontinuation; and Establishing protocols to assess risk, and address potential harms of opioid use. Click http://www.fafp.org/webinars to register and sign up for your FREE account to earn CME credits at no cost to you. We look forward to your participation!

FAFP President Dr. Diana Twiggs formally presented the recently approved 2017-20 FAFP Strategic Plan. "Supporting Florida's Family Physicians" highlights the fact that everything the FAFP does is focused on the organizational vision of "Improving Florida's Health through Family Medicine." A micro-site has been established to share with members these new statements and provide greater detail relative to the four organizational goals: Advocacy, Education, Practice Improvement and Academy Strength. To learn more about the strategic direction of YOUR FAFP, go to: http://www.fafpstrategicplan.com/

The Florida Academy of Family Physicians (FAFP) Board continues to recognize the need to support FAFP members who are prepared to become recognized by the National Committee for Quality Assurance (NCQA), Accreditation Association for Ambulatory Health Care (AAAHC) or Joint Commission as a Patient-Center Medical Home (PCMH). Such recognition is becoming increasingly important due to the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and associated Merit-Based Payment Systems (MIPs) and Alternative Payment Models (APMs) that reimburse PCMH practices with enhanced payments. The FAFP will incentivize, for the first 25 participating FAFP member office practices, a flat amount (see below) of an office practice's consultation expense when contracted with the Center for the Advancement of Health IT (AHIT) or the University of Central Florida College of Medicine’s HealthARCH (HealthARCH). Each program has been vetted by the FAFP and offer members a choice based upon their practice’s needs. Getting Started: Please visit: http://www.fafp.org/practice-enhancement for more information and to sign up. You may also review FAFP’s partnerships with the Center for the Advancement of Health IT (AHIT) and the University of Central Florida College of Medicine’s HealthARCH (HealthARCH) or contact Jennifer Young, FAFP Director of Membership and Practice Enhancement at jyoung@fafp.org, 904-726-0944.

Q: Where can patients safely dispose of unused medications? A: Walgreens has developed a new programs to help curb the misuse of medications and reduce the rise in overdose deaths. With this, Walgreens has installed safe medication disposal kiosks in over 500 pharmacies across 35 states. These medication disposal kiosks provide a safe and convenient way to dispose of unwanted, unused or expired medication at no cost, year-round. Kiosks are currently available during regular pharmacy hours and offer one of the best ways to ensure medications are not accidentally used or intentionally misused by someone else. For more information, click here. For information on Drug Enforcement Administration (DEA) guidelines on drug disposal, please click here.

Learn about common geriatric clinical problems, chronic diseases, ways to improve quality of life, and more. Register for the AAFP's Geriatric Medicine live course in Orlando (Lake Buena Vista) Oct. 14-17. Learn the latest on common geriatric clinical problems that include cholesterol and risk calculators, a hypertension update, an immunizations update, and more. Further develop your adherence to evidence-based clinical guidelines in practice, communicate diagnosis and treatment recommendations more effectively with your patients, and better construct strategies to diagnose, treat, and manage geriatric conditions. NEW FORMAT: HALF-DAY COURSE Earn CME in the mornings and then enjoy your own afternoon activities at an Official Walt Disney World® Hotel. Use the time to relax and create memories, reflect on the education, and come back the next morning refreshed and ready to learn. Earn up to 17.25 AAFP Prescribed credits in the mornings and enjoy your own afternoon activities at Disney Theme Parks AAFP members: $795/nonmembers: $1,095 until Sept. 15 After Sept. 15, AAFP members: $895/nonmembers: $1,195 Save when you register by Sept. 15. Register now or call (800) 274-2237.