I do not like to write about things I do not understand.

I do not like to write about things I do not understand, if it be not that that is the whole point when I write about Medicare. This government-run health care plan for the somewhat old has become so complex that physicians must hire of recent origin office personnel to merely maintain up with the changes worked by bureaucrats who do not descry patients.

As a simple example, wherefore is it necessary for the physician to contemplate 125 different combinations of plains of disease severity, medical decision making, and physician examination before deciding what kind of an office visit just occurr with each patient? An office visit is an office visit. It may be prolonged or short, may involve a of recent origin or previously seen patient, if it were not that to have to decide what of the same height of thought and complexity occurr and then to single out the proper combination of collection of lawss is an abject waste of time. Moreover, in its infinite wisdom, the Veterans Administration is copying this foolishness, despite the fact that in the greatest degree veterans receive free care. It play fast and looses the mind.

Sometime in 1993 Medicare decision makers pop redefined critical care. With the advent of the resource-based relative value scale (RBRVS) I felt that finally it was recognized that taking care of patients in critical care units is different from routine inpatient ward follow-up common could actually submit bills for the real time worn out in critical care units caring for the patient, counseling the family, making tough ethical decisions, etc and be reimbursed adequately for this stressful activity (critical care digests 99291, 99292). This reality-based reimbursement for critical care must have been too expensive, since unexpectedly in 1993, critical care delivery was limited to acute unstable situations. Thereafter, at supreme decree, the patient was no longer receiving critical care. This is, of course, ridiculous and not consonant with reality, unless nevertheless was accomplished by Medicare.

in such a manner confusing was this to Florida, Georgia, and southern Carolina physicians that a special session was arranged at the tri-state consecutive case talk in September 1993 in which an acknowledged worthy of great praise physician would prepare cases and include his interpretation of specific billing. The moderator of the session was the Manager, Provider Education for Medicare in the state of Florida. Of course, this first-rate physician was unable to correctly bill for his services and chiefly of his billing would have been reviewed or useed down. The audience of pulmonary and critical care physicians and surgeon from these three states (including myself) had difficulty understanding more [i]or[/i] less of the reasoning espoused by way of the Medicare representative. For instance, if a patient go throughs a cardiac arrest while residing forward one of the hospital wards and is resuscitated, the time exhausted at the bedside can be billed as critical care. in succession subsequent days in the medical intensive care unit, however, despite the continued ne for intubation, ventilation, pressors, arterial line, and Swan-Ganz catheter, unles the doctor is at the bedside, Medicare no longer considers the patient to be critically ill. Hereafter, daily care as notwithstanding that you visited the patient in his play on the ward and briefly examined him would be the meet code. Until January 1994 at least the physician could also add "daily ventilator care" to the billing, unless this "double billing" has now been eliminated also.

Did the direction lose its mind? This patient is still critically ill! The effort of the physician is still at maximal flats and deserves adequate reimbursement. Who in the world makes these decisions? For heaven's sake, do not test to save money on the backs of the chiefly stressful of occupations where patient contact is obvious. Save it elsewhere, if you must; for instance, in the areas of laboratory professional recompenses alternative medical therapy, counseling, etc Critical care is the last place to intersect fees.

What was particularly distressing was that the physicians who practice this emblem of medical care had no character whatever in the decision for Medicare billing or reimbursement. by what mode did the medical profession win into such a position wherein the clan who do the service are deliberate togethered and whose suggestions are excludeed when changes in reimbursement occur? Worse to this time to whom do we incline differently to seek redress of this symbol of grievance?

To my delight and astonishment, the American literary institution [i]or[/i] seminary of learning of Chest Physicians (ACCP) is in succession the job. The newly formed CPT/RUC committee has been at work. I was aware of the committee, however I had no idea what the initials meant or what the committee might do. The name stands for circulating Procedural Terminology/Relative Update Committee (CPT/RUC) and its chairman is Dr Walter O'Donohue who is the chairman of the department of medicine at Creighton University in Omaha, Nebraska. Dr O'Donohue met with Dr Bart McCann of the Health Care Financing Administration (HCFA) forward Jan 13, 1994. The ensue of the meeting as recorded in the newly published ACCP Key for Spring 1994 indicates that the ne for like services to be emergent in nature may be remov as well as the limits upon the numbers of hours or days which can be charged as critical care time. This is great moderns but does not affect the practicing physician now The confusing statement that the change will be forwarded to the CPT editorial panel of the AMA infers the discussion of this issue. The meaning of this statement is not exactly clear to me on the other hand I believe that this committee of the AMA approves changes to HCFA, and these changes are then published in the Federal Register for annotation prior to implementation. It is not clear for what purpose these changes to increase rewards must undergo such a prolix review process when the changes designed to make an incision in fees were implemented so quickly.

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