Andrew W. Murphy, MD, FAAAAI
* This interview appears in the July/August 2017 issue of JACI: In Practice.
We continue our series of interviews with the members who make up the AAAAI Office of Practice Management. Keep reading for our interview with Andrew W. Murphy, MD, FAAAAI, and hear more about how this group supports the practicing allergist with the Practice Matters newsletter. Dr. Murphy is Practice Matters Editor and was recently appointed the new Chair of the Office of Practice Management, carrying on the work done by past Chair Linda Cox, MD, FAAAAI.
How does your experience as a practicing clinician inform your role as Editor of Practice Matters?
The day to day practice of medicine has become incredibly complicated. Gone are the days of walking into an exam room and simply providing medical care and then being reimbursed fairly for that service. As a solo practitioner I am acutely aware that physicians today must assume numerous additional roles aside from our main role of physician. These expanded responsibilities include: medical informaticist, marketing expert, quality expert, social media/digital expert, MACRA/MIPS expert and a whole slew of other responsibilities that we never thought would invade the patient-physician relationship. As Editor of Practice Matters I am constantly looking for information that allows our members to understand these varied roles and, more importantly, what resources can be provided to make physicians lives easier. The practice of medicine is certainly in the middle of a major frameshift that will clearly have short term and long term implications. Our goal for Practice Matters is to help you, the clinician, manage these changes and make this turbulent time as smooth as possible.
How does Practice Matters content enhance the AAAAI’s services to members?
When I first joined the AAAAI Board of Directors I quickly realized the extent and breadth of work that the AAAAI does on behalf of our members. I also realized that we were not doing a very good job of communicating these efforts to members nor were we doing a very good job letting members know of the resources available through the AAAAI. The conception and development of Practice Matters was to specifically address these issues—that is to update members with relevant and timely information that effects the practice of A/I. I think it is important to point out that the “practice” of A/I includes all practice types from solo practitioners to those employed in complex healthcare systems. In addition, with all the changes occurring legislatively and on the regulatory side, Practice Matters has been a great complement to current AAAAI resources to make sure members are aware of relevant policy actions that directly, or indirectly, effect the practice of A/I. In addition, the “Coding Question of the Month” and the “Ask the Coding Expert” service at email@example.com have been incredibly invaluable resources for ongoing common and complicated coding questions that members have and the AAAAI coding team answers. Finally, our partnership with JACI: In Practice on the Practice Changers in each issue grounds Practice Matters back to patient care.
What do you envision for the future of Practice Matters?
Practice Matters is coming up on its third anniversary and I am very pleased where we have been but we need to continue to move forward. We have been very successful in that the “open rates” of Practice Matters exceed industry standards and I believe this reflects the relevance of the information for our members. However, today’s "24 hour news cycle” affects the practice of medicine in ways that we would not have anticipated just a few years ago and we need to do an even better job of making sure members are aware of the issues we may face. The digital age we have entered offers incredible opportunities to reach out to our members and the Practice Matters team is exploring new and innovative ways to deliver timely practice related information.
Paul V. Williams, MD, FAAAAI
* This interview appears in the March/April 2017 issue of JACI: In Practice.
We continue our series of interviews with the members who make up the AAAAI Office of Practice Management. Keep reading for our interview with Paul V. Williams, MD, FAAAAI, and hear more about what this group does to support the practicing allergist in regards to healthcare organization relations. Detailed information about the Office of Practice Management can also be found here.
How does the Office of Practice Management serve the practicing clinician?
Through our subscription to Policy Reporter, we are informed about recent and upcoming changes to payers’ policies, including commercial and government insurers, which affect the practicing allergist. We are able to provide input to the insurers to try to influence that policy for the health and safety of our patients, and also alert clinicians about policies that may affect their practice. We also provide coding tips and respond to coding questions at firstname.lastname@example.org to help our clinicians navigate the intricacies of the billing process.
Can you share your thoughts regarding the AAAAI’s increasing emphasis in reviewing payer policies and your insights into the benefits this offers membership?
This is partly answered in the question above, but I think the AAAAI’s emphasis shows how interested they are in helping the clinician. We do have “wins” with our communications with insurers, with changes to policies that improve the health and safety of our patients.
What trends in payer compensation have you observed in your role as a member of the Office of Practice Management?
The most common trends we are seeing that are making their way through the payers are limitations in skin testing numbers and allowed number of doses per year in immunotherapy. It appears that insurers do not really understand immunotherapy. This is a problem that we are continuing to work on.
Linda Cox, MD, FAAAAI
Office of Practice Management Chair - 2016
* This interview appears in the January/February 2017 issue of JACI: In Practice.
Beginning with this issue of JACI: In Practice, you will be able to read interviews with the members who make up the AAAAI Office of Practice Management and hear more about what this group does to support the practicing allergist. Continue reading for our first interview with Linda Cox, MD, FAAAAI, who chairs the Office of Practice Management.
How does the Office of Practice Management (OPM) support the daily work of the practicing clinician?
The OPM has six ‘spokes’ or components:
1. Practice Matters, a monthly e-newsletter that provides a brief summary of an array of current topics and issues relevant to practicing clinicians.
2. Practice Management Workshop, a three-day annual workshop that focuses on the day to day issues that all A/I physicians face—whether in solo private practice, a multi-specialty group or the academic setting. It is specifically programmed by practicing allergists for practicing allergists. Since 2004, the AAAAI has held 11 Practice Management Workshops dedicated to the business of A/I practice.
3. AAAAI Quality Clinical Data Registry (QCDR), which was launched in 2014. A qualified clinical data registry is one of the reporting mechanisms for the Physician Quality Reporting System (PQRS). PQRS is considered a pay for reporting program and initially it was associated with incentive payment. However in 2015, the program began to apply a negative payment adjustment to individual eligible professionals and PQRS group practices who did not satisfactorily report data on quality measures. For example, those who did not comply with the program in 2015 would face a negative payment adjustment or penalty in the 2017 calendar year. The Centers for Medicare & Medicaid (CMS) rules and regulations regarding physician payment have continued to evolve and have become increasingly more complex.
Next year CMS payment is moving to an entirely new platform of value-based payment, which of course comes with new acronyms and fines because non-participation can result in significant payment penalties. Some of the new acronyms you may have heard include the Medicare Access and CHIPS Reauthorization Act (MACRA), Merit-based Incentive Payment Systems (MIPS) and Alternative Payment Models (APMs).
MIPS is in essence a combination of PQRS, the Value Based Modifier, and Meaningful Use. It requires reporting in four areas, each weighted to reflect CMS priorities. These four areas include Quality Performance, Clinical Practice Improvement Activities, Advancing Care Information and Resource Use. The Resource Use component will draw data from claims filed with CMS, meaning that piece does not require separate reporting.
The good news is the AAAAI has you covered. You can fulfill your MIPS requirements through a qualified clinical data registry, like the one offered by the AAAAI since 2014.
For complete information on the AAAAI QCDR, visit aaaai.org/qcdr.
4. Coding information and resources: The AAAAI is your source for coding expertise. With the help of AAAAI coding consultant Teresa Thompson, we triaged nearly 1,000 coding questions in 2015. A timely coding question and answer is also featured in every issue of Practice Matters and all of the coding questions and answers are categorized by topic and listed on the AAAAI website. You can find our collection of coding questions and answers by visiting.aaaai.org/practice-resources/running-your-practice and clicking on Coding from the options on the right side of the page.
5. Legislative and regulatory advocacy: The OPM reviews regulatory and legislative reports on a daily basis. The two firms the AAAAI works with, Hart Health Strategies and Washington Health Advocates, help strategize and respond to key topics affecting the specialty.
6. Healthcare organization relations: The OPM tracks and analyzes trends data from payers across the country through a service called the Policy Reporter. On a monthly basis, the OPM helps craft correspondence to address issues ranging from compensation for drug allergy testing to insect hypersensitivity immunotherapy services, and from treatment for allergic rhinitis due to animals, cat, dog hair and dander, to treatment for asthma.
The 2016 Practice Management Workshop featured practical discussions and new ways for the clinician to enhance his or her day-to-day business practices. Can you share some examples of what you learned? Why would you urge others to attend this annual event?
It is worth it just to attend Teresa Thompson’s coding workshops. Everything you need know is covered in her basic and advanced workshop.
In this rapidly evolving healthcare landscape, with rules and requirements that are so complicated even the sharpest practice administrator can’t keep up, the Practice Management Workshop provides information and guidance from experts who have digested them. For example, Emily Graham, RHIA, CCS-P, Vice-President of Regulatory Affairs at Hart Health Strategies, gave a presentation that helped explain MACRA in way that I more easily understood.
Another session from the 2016 Practice Management Workshop that more than paid for itself was “Don’t Leave Money on the Table! Managing Cash Flow in a High Deductible Health Plan World” presented by Brian August, MBA, and John Milewski, MHA, FACMPE. It gave me tons of ideas on how to improve cash flow in my practice that I have since been exploring, such as examining our credit card merchant fees (I subsequent changed merchants) and encouraging patient registration via the internet when they call to make an appointment. I have already received positive patient feedback from the latter because they are spending less time filling out forms in my waiting room.
“Analyzing and Improving Work Flow in Your Practice” presented by Owen J. Dahl, MBA, FACHE, CHBC, LSSMBB, prompted me to do the same in my practice and hopefully the changes we have implemented will translate into a better experience for patients, who generally are not keen on seeing a doctor, let alone spending hours in waiting and exam rooms waiting to see them while someone is inputting their data into the electronic health record.
Unfortunately, space will not allow me to list all of the practice pearls I gleaned, but I encourage all A/I clinicians to attend or send a practice representative to the 2017 Practice Management Workshop. It takes place July 14-16 in Rosemont, Illinois by Chicago’s O’Hare International Airport. Registration will open March 1.
What has been most surprising or eye-opening about being involved in the Office of Practice Management?
The eye-opener for me is how much effort, staff, funds and resources AAAAI has committed toward supporting practicing clinicians and the A/I specialty.