Letters
Three cheers for solo
practice
To the Editor:
Wow! What a forthright, cogent and timely article ("Solo Practice: The Way of the Future," February 1998). My thanks to Family Practice Management for publishing such a counterculture viewpoint that renders moot and void quite a few of the very articles you publish each month. In 1993, we were told to jump on the Clinton-care bandwagon since its adoption was inevitable. Wrong. And universal managed care and all other forms of centralized control are also not the inevitable tsunamis that the media would have us think.
Dr. Iliff's analogy about personal computers ousting mainframes is exactly right. No centralized control mechanism can ever approach the freedom, flexibility and performance of a diverse market of fully functioning individual physicians.
By the way, I must not be an "average academician" because upon reading this article I immediately routed it to all our residents and faculty, thus doing my part to promote the "independent model of practice."
William M. Chop Jr., MD
Waco, Texas
Editor's Note:
Dr. Iliff's article has prompted a flood of responses from readers sharing their thoughts on the future of solo practice. In an upcoming issue, Family Practice Management will feature excerpts from selected responses.
A side effect of the new coding
rules
To the Editor:
Your series of articles on HCFA's new Medicare documentation rules are timely and appreciated.
What is missing in this rush to comply with HCFA's rules is any analysis of the cost-benefit ratio and other ramifications of these onerous regulations. Even with your coding tools, it appears that strict compliance with these rules would require five to 10 minutes for accurate coding and additional time for complete, supportive documentation. For anything above a 99212, coding and documentation could easily require as much time as that required for the actual service. To devote more time to paperwork, physicians must either see fewer patients per day, thereby decreasing access, or spend less time with patients, thus decreasing quality of care. Some physicians may simply choose to stop seeing Medicare patients. Unfortunately, insurance companies will likely try to adopt these same guidelines in the future.
I urge the AAFP and the AMA to consider all the problems created by HCFA's guidelines and to work with Congress to stop or change them before it is too late.
James R. Hill, MD
Denver
Clarification
The table of exam content and documentation requirements that appears in the Pocket Guide to the Documentation Guidelines and Quick-Reference List (see "Three Documentation Tools That Work," January 1998) notes that "For the comprehensive exam, all bulleted elements must be performed." This note is not meant to suggest that all 59 bulleted elements listed for the comprehensive exam must be performed. Rather, it addresses a distinction made in the guidelines for documenting multisystem exams, which is explained in an aptly titled article from our October 1997 issue, "Exam Documentation Just Got Harder." While the guidelines require that at least 18 bulleted elements from at least nine systems or body areas be documented, they stipulate that all bulleted elements in the systems and areas examined be performed.
We want to hear from you. Letters is an open forum for our readers. Write to Letters Editor, Family Practice Management, 8880 Ward Parkway, Kansas City, MO 64114-2797. If you prefer, fax your letter to 816-333-0303. You may also contact FPM by E-mail at fpmlet@aafp.org. Include your address, daytime phone number and fax number, if any. Letters may be edited for length and style. All letters sent to the editors of FPM are presumed to be intended for publication unless otherwise specified in the text of the letter.
Copyright © 1998 by the American Academy of Family Physicians.
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