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Try diversity in medical homes, and other letters


By Modern Healthcare
Posted: October 27, 2012 - 12:01 am ET
Tags:

I can't believe that the American Academy of Family Physicians in the 21st century would fail to represent the diversity of leadership required to address the broad-ranging restructuring of primary healthcare services (“Sore subject,” Oct. 8). Recall that the existing fragmented primary-care system has long been unilaterally led by physicians, and it's clear to see where that has taken us. And the AAFP view emerges at a time when there is increasing evidence that the capacity for preparing sufficient M.D. practitioners for primary care cannot and will not meet demand for quality primary-care services. Interestingly enough, there is overwhelming evidence that well-prepared and competent nurse leaders and nurse practitioners will be prepared in adequate numbers to fill those roles with already well-validated high levels of clinical excellence and patient satisfaction. To ignore that data is both pejorative and shortsighted. A well-designed and effectively coordinated complex healthcare system will require well-calibrated distributive decisionmakers from a variety of roles and perspectives building concerted partnerships that represent equity and integration in a multidimensional service framework. The lingering hierarchical and historically vertical control models of relationship across the disciplines will not create an even table for provider and community partners, many of whom will need to lead efforts for advancing and sustaining truly healthy communities for the future. I hope the demands related to building such a system have not now eclipsed the capacity of AAFP leadership as suggested by this report.

Tim Porter-O'Grady
Senior partner
Tim Porter-O'Grady Associates
Atlanta


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Blame outdated coding system

I read the op-ed article in the Oct. 8 issue (“Check, please”) with great interest, and I, too, had a “shaking my head” moment. The issue I think should be investigated more is why the Current Procedural Terminology (CPT) coding system is still in place. Of all the variables in our healthcare system that have been modified, tweaked and/or removed, the CPT code has yet to have a makeover. You will be surprised how many CPT codes exists for a single procedure/evaluations and all come with a confusing explanation/definition. It is no wonder why practices and hospitals alike have to hire specialized coders and billers just to be able to navigate the system. Your example of a simple anniversary weekend ought to be a microcosm (or macrocosm) of healthcare. You see a doctor, get things done and pay what is owed. In most instances, the billing and reimbursement for service is done in a timely manner, yet most practices like mine still have accounts receivable that are older than 90 days for various reasons. One of them is the appropriateness of the CPT code being used. The CPT code may not match the diagnosis the insurance company is reviewing, etc. EHR solutions are helping, but not enough yet. The point is that in your case, this might be what is going on or it could be just poor billing practices by the hospital, but it all starts with the complex world of coding. Ask the American Medical Association, the one that created this hydra as a way to supposedly uniformly communicate with providers, insurers, etc. Our current system and where it is heading is making the CPT code a burden and likely to be obsolete as “bundling” of payments becomes more of a reality. Why has this not even been addressed, especially since all billing starts and depends on this chaotic system?

Dr. Alan Ackermann
Medical director/owner
Aventura (Fla.) Institute for Cardiovascular Wellness


It's a byzantine industry

Regarding the Oct. 8 editorial (“Check, please”), the restaurant is owned by an entity that sets the price, controls the menu, sets the hours of operation, etc. Your healthcare is delivered by multiple entities of variable sizes, with different “supplier” contracts, with different menus and different “chefs,” in a rapidly changing environment. It is more complex than any hotel or restaurant you have ever seen. That's why it is byzantine and difficult to know costs. It would be nice if it weren't so complicated, but it is.

Dr. Michael D. Bryan
Southlake, Texas


Time to fix physician payment

Regarding “Romney rallies clinician supporters in Congress" (Modern Physician, Oct. 11), if Mitt Romney is elected and successful in ending Obamacare, my hope is that this will eventually lead to a single-payer system, such as promoted by Physicians for a National Health Program. I have to chuckle with frustration that a physician, Rep. Michael Burgess (R-Texas), would introduce legislation that would provide a one-year extension of physician Medicare payment rates. Why not introduce legislation to reform the sustainable growth-rate formula? Stop “kicking the can down the street” with one-year extensions and enact meaningful legislation.

Dr. Christopher Goeser
Salem, Ore.
Medical director of imaging
Silverton (Ore.) Hospital
Diagnostic Imaging Association



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