From AI to polypharmacy: eight practice pearls from FMX 2024

Thousands of family physicians gathered in Phoenix last month for FMX, the American Academy of Family Physicians' annual conference, which offered clinical, practice, and career educational tracks. Here are our top eight practice pearls from the conference.

1. AI can be helpful for documentation, less helpful for nuanced tasks

AI-powered ambient documentation support (i.e., an AI scribe) is a game changer, unburdening physicians and allowing more patient-focused time. But AI is less helpful for tasks that require nuance and do not have a clear right and wrong answer. — Lisa Rotenstein, MD (See also "The Promise and Pitfalls of AI in Primary Care.")

2. G2211 good news on the horizon

The 2025 Medicare Physician Fee Schedule preliminary rule proposes allowing the G2211 add-on code for visits where modifier 25 is used and for annual wellness visits if the visit meets the other code requirements. Documentation for the code can be as simple as "patient here to establish care" or "will return in six months" to demonstrate ongoing care. — Tom Weida, MD

3. GLP-1 prior auth approval tips

For GLP medication prior authorization approval, documentation is key (see tips below). But if the insurer simply doesn’t cover the drug, then talk to the patient about alternative anti-obesity medications and treatments or cash-pay options. — Carolynn Francavilla Brown, MD

4. Hospital privileging requires being strategic

Privileges should be granted regardless of specialty as long as training criteria and experience are documented. To obtain hospital privileges for procedures 1) Practice in a community where your skills are valued and needed, 2) Identify allies, 3) Use "cheerful persistence," 4) Be truly excellent at patient care and maintaining skills, 5) Get on your medical executive committee, and 6) Have your patients on the hospital board. — John Cullen, MD

5. Improving performance is a team effort

The effectiveness of your care team is crucial to improving performance, particularly under value-based care models, so make sure you map out roles and communicate well. Use daily team huddles to discuss the following topics:

• High-risk patients,
• Hospital, emergency department, or nursing facility follow-up visits,
• Results or referrals needed for the day,
• Patient-specific issues,
• Clinician and staff scheduling issues (who's out, leaving early, etc.),
• Patient scheduling issues (back-to-back lengthy visits, openings, etc.),
• Potential bottlenecks/work slowdowns,
• Safety issues (sound-alike names, equipment issues, etc.),
• Patient risk levels.
  — Kim Yu, MD

6. Leadership is multifaceted

Exemplary leaders do five things (per authors Jim Kouzes and Barry Posner): model the way, inspire a shared vision, challenge the process, encourage the heart, and enable others to act. — Lisa Belisle, MD, PhD, MPH, MBA, CPE

Your natural leadership style — delegating, supporting, coaching, or directing — may need to shift depending on who you’re leading and what the situation calls for. — Peter Seidenberg, MD

7. Malpractice lawsuits are a reality of practice, so learn what to expect and how to respond

An estimated 88% of physicians will be named in a malpractice suit in their career. Although it is an unfortunate reality of practicing medicine, you can lessen your risk by having good outcomes, of course, but also by creating reliable systems for tracking test results, strong relationships with patients, and excellent documentation. If you receive the dreaded letter notifying you of a lawsuit, breathe and contact your malpractice company, who will assign a lawyer and direct you in next steps. Do not alter records, look in the chart until your lawyer tells you it is OK, or talk to others about details. — Mary Krebs, MD

8. Polypharmacy in the elderly

Any symptom in an elderly patient should be considered a drug side effect until proven otherwise. Beware common "prescribing cascades" (see image below).

To reduce polypharmacy in the elderly, do the following: 1) Avoid starting Beers Criteria medications, particularly those that cause physical dependence, 2) Recognize potentially inappropriate medications and deprescribe when appropriate, 3) Pay extra attention to medication lists in patients with recent transitions of care, 4) Consider total anticholinergic burden, particularly in patients with cognitive impairment, 5) Incorporate patient priorities and prognosis in medication reviews, and 6) Recommend lifestyle interventions where appropriate. — Ariel Cole, MD, CMD

Posted on Oct. 7, 2024 by FPM Editors