Letters

High praise for maintenance of certification

To the Editor:

It was disheartening to read the uniformly negative and pessimistic letters about the American Board of Family Medicine's maintenance of certification initiative [Letters, March 2005, page 14]. I, for one, am in favor of maintenance of certification. In fact, I would like to see us tested even more regularly. Ensuring family physicians' understanding of and adherence to accepted, evidence-based standards of care - something I trust is the thrust of the self-assessment modules - is laudable.

Kent S. Jeffery, MD
Wabasha, Minn.

Human touch trumps technology

To the Editor:

Thank you for the articles on electronic health records (EHRs) in the February 2005 issue. I appreciate the work done by the pioneers who have furthered the use of EHRs in family medicine. I only hope that we have a truly functional health information infrastructure while I am still in practice.

I also appreciated the piece by Dr. Carla Jardim ["Making the Most of Every Minute," page 80]. Her comments led me to reflect on the things that set physicians apart from technicians. Perhaps fear of undermining the physician-patient relationship is what has kept physicians from embracing the EHR for so long. If so, it was a good reason. How we interact with people is as important as the information we give them.

Gary Arvary, MD
Blairstown, N.J.

Coding ECG and IPPE

To the Editor:

I was hoping you might have more information on how to coordinate the billing of an electrocardiogram (ECG) with the Medicare initial preventive physical exam (IPPE) ["How to Conduct a 'Welcome to Medicare' Visit," April 2005, page 27]. Do you need to wait to submit the claim for the IPPE until the ECG is in the chart?

Jill M. Young, CPC
East Lansing, Mich.

Editor's response:

According to Cynthia Hughes, CPC, coding and compliance specialist for the AAFP, all elements of the IPPE - including the ECG - must be performed before the IPPE is billed. She checked with the Centers for Medicare & Medicaid Services and received this clarification: "We encourage physicians to ensure the ECG has been performed before submitting a claim for an IPPE. Post-pay audits may be conducted to determine if claims paid for the IPPE were paid appropriately."

If your practice won't be performing ECGs on site, Hughes recommends scheduling patients' ECGs to occur prior to the IPPE. This will allow the physician who performs the IPPE to have the ECG result and discuss it with the patient at the time of the IPPE. However you choose to handle the ECG, confirmation that the ECG has been performed must be obtained and the patient chart should include a note to that effect prior to billing Medicare for the IPPE.

Chaperoning becomes catch-22

To the Editor:

"Should You Treat Yourself, Family or Friends?" [March 2005, page 41] got me thinking about a recent trip to China with my son's high school band. When my 200 fellow travelers found out I was a doctor, my hotel room (or the bus or elevator I happened to be on) became an exam room.

I had tried not to let on that I was a doctor, but these things have a way of being discovered. Mostly I did triage. The biggest decision I made was to replace a woman's lost blood pressure medication with a similar one available to us - after doing a brief history and physical. Another woman was hospitalized at my suggestion to rule out pneumonia, and the rest of the diagnoses were a variety of minor ailments such as URIs, rashes, labyrinthitis and twisted knees.

WE WANT TO HEAR FROM YOU

Send your comments to fpmedit@aafp.org. Submission of a letter will be construed as granting AAFP permission to publish the letter in any of its publications in any form. We cannot respond to all letters we receive. Those chosen for publication will be edited for length and style.

I'll probably be asked to chaperone other band excursions, and I'm not sure how to handle it. You can't ethically abandon your buddies while traveling, but you don't want to be bit later on. Any advice?

Keith Rayburn, MD
San Martin, Calif.

Author's response:

I would recommend keeping some record of any encounter that involved writing prescriptions for medication. It would also be good to make clear that you are making an exception to your normal practice of not treating friends because of the difficulties of accessing care in China. If future trips are scheduled to less remote locales, you might consider being less willing to act as "band doctor."

Robyn Latessa, MD
Asheville, N.C.

The "Aurora rule"

To the Editor:

A good reason to X-ray everyone with a suspected internal derangement of the knee is that many imaging facilities won't do an MRI without prior plain films. If you think an MRI is in your patient's future, you can save time and just order the plain films while you're thinking about them, regardless of what the Ottawa and Pittsburgh rules say [see "A Tool for Evaluating Patients With Knee Injury," March 2005, page 67].

Frank P. Reynolds, MD
Aurora, Colo.

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