The American Medical Association last week boasted of securing a six-month delay in enforcement of new documentation rules for office visits billed to Medicare.
But that didn't satisfy some angry doctors, who said the Evaluation and Management Guidelines, which the AMA helped develop, will overburden them with paperwork. The AMA House of Delegates, which met earlier this month in Dallas, voted to seek regulatory changes to reduce the requirements, which are intended to battle fraud and abuse.
Physicians said increased documentation will rob patients of time with their doctors. In many cases, they said, the rules require irrelevent information about a patient's condition.
Georgia delegate Thomas Price, M.D., said the rules would lead to "criminalization" of medicine. He said organized medicine should not "work in complicity with the federal bureaucracy.
"The premise of these rules is that if it isn't documented it didn't occur. If you perform an exam, charge for it appropriately, but fail to document it adequately, you may be subject to civil penalties of $10,000 per claim," Price said.
The Georgia delegation called for a test period in a specific geographic area to determine impact on costs and patient care.
Minnesota delegate Audrey Nelson, M.D., of the Mayo Clinic, said the clinic estimated it could cost $600,000 a year to implement the new requirements.
A proposal calling for the AMA to work to rescind the rules failed by one vote after trustee Nancy Dickey, M.D., pleaded with delegates to continue to cooperate with HCFA. "If we don't like the criteria, let's change the criteria. But let's not kid ourselves that we're going to get rid of them," she said, evoking applause.
A grace period for following the new guidelines was extended until July 1, 1998. Physicians must, at a minimum, meet existing documentation standards, which were adopted in 1994. HCFA has urged doctors to adopt the new guidelines as soon as possible.
A HCFA representative told an AMA committee last week that random audits have begun on a small sample of claims, and practices will be judged under the set of guidelines most favorable to them.