July/August 1998 Table of Contents
Medicare Update
AMA House Rejects 'New Framework,' Votes to Oppose Quantitative Documentation Guidelines
The AMA House of Delegates passed a resolution at its annual meeting in June to "oppose any documentation system that requires quantitative formulas or assigns numeric values to elements in the medical record to qualify as clinically appropriate medical record-keeping." At press time, it was still unclear what effect the resolution would have on the documentation guidelines or on the AMA-HCFA collaboration that has produced them.
Douglas E. Henley, MD, family physician and member of the AMA's CPT Editorial Panel, says the panel's work "has come to a screeching halt" pending the results of AMA-HCFA negotiations.
A HCFA official says that HCFA must move forward with development and implementation of a set of documentation guidelines, "regardless of the outcome of those discussions." Robert Berenson, MD, director of HCFA's Center for Health Plans and Providers, says "the resolution would essentially nullify the guidelines without providing any viable alternative."
Henley hopes the AMA will continue to be part of the development process. "It appears that HCFA feels very strongly that some sort of quantitative system of guidelines will be necessary," he says. "If HCFA maintains that stance, and I think they will, the question will become whether the AMA wants to be involved. If the AMA opts out, we'll probably have to live with 'black box' criteria developed by HCFA."
The CPT Editorial Panel, HCFA and AMA leaders have been working for several months to develop a "new framework" for the documentation guidelines. The new framework is a simplified version of the revised guidelines that drew widespread criticism upon their release last year. In April, HCFA consented to appeals from organized medicine to delay implementation of the revised guidelines so that further changes could be made. However, random prepayment reviews of Medicare claims have continued, and physicians' documentation must comply with either the original 1994 guidelines or the revised version released last year.
Copyright © 1998 by the American Academy of Family Physicians.
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