One commenter thought that I blamed the suits for the billing codes. I never said that. I blame the suits for misinterpreting the logic behind the billing codes. The suits see medicine purely as a business. Given the current billing codes, you maximize profits when you see patients in less time. Many physicians have become suits in the way they think about their practice.
Regardless of who developed the billing codes, I believe that we physicians must point out the major unintended consequence of billing codes – shortening visit length only for billing purposes.
We must make this problem clear to everyone involved in addressing health care. I believe that those who do not understand this problem cannot possibly improve health and control costs.
As I said in the previous post, shortened visits means that physicians rely on testing and imaging rather than taking a careful history and doing a careful physical exam. Shortened visits and our current billing discourage many physicians from telephone calls and email communications.
Shortened visits decrease both patient and physician satisfaction. We must fix this problem or we really cannot address the overall health care system.
{ 3 comments… read them below or add one }
One interesting difference between the Australian billing codes and the US ones are that complexity is not defined by how many systems are involved, or how many systems you put into the RoS. Instead the levels are defined on time: 60min. Now, this means that a 39 minute consultation only pays 50% more than a 6 minute one, but with standard booking practices (and the HIC does review how many of each you see in a day), most people will see a Level B (6-20) in 15 minutes, and a level C (20-40) in 30 minutes. The brackets are just so that you have no incentive to hurry the patient out the door unnecessarily.
Keep in mind that the source of billing codes and our RVU system goes back to the AMA which is specialty dominated and heavily biased in favor of proceduralists over cognitive specialties. The system makes sense and works well for partialists/proceduralists but is terrible for us cognitive based comprehensivists.
Since no change is in sight for the E&M CPT codes any time soon, any system based on the cpt codes for visits is going to encourage short visits and more patients/hour.