Letters

What's all the fuss about coding?

To the Editor:

I feel like a voice in the wilderness when I say that from a primary care perspective, I can't understand all the fuss about coding. Proper coding and documentation for accurate reimbursement can't be made much easier, especially for established patients. Yes, 99215s and new patient codes are problematic, but realistically they make up a small percentage compared with the now easy to code and document 99212s to 99214s. There now is (was) a system that not only helps us code more appropriately (resulting in increased reimbursement) but virtually protects us from the dreaded specter of an audit. The system is relatively easy to learn if my colleagues would only take the time to learn a few key points.

The cries of interference in the doctor-patient relationship are, in my opinion, a cover for an unwillingness to adapt to the changing terms of reimbursement. I feel the AAFP has wasted a lot of political capital by fighting this instead of educating its members like Family Practice Management is attempting to do.

J. Yates Sealander, MD
Madison, Va.

Make good with imperfect data

To the Editor:

"It's Time to Start Practicing Population-Based Health Care" (June 1998) was a great article -- very applicable to family practice. The advent of computerized record keeping will facilitate more of this everyday practice.

One of the most helpful points in the article was, to plagiarize from Nike, "Just do it." I think those of us who are interested in quality improvement on the office-based-practice level can get hung up on trying to have complete databases and comprehensive data. While this might be nice in a pure sense, the interventions we may make even with less-than-complete information will have an impact for the better.

Paul Mayeda, MD
Kirkland, Wash.

Staff surveys tell more than patient surveys

To the Editor:

In "Using Qualitative Self-Evaluation in Rating Physician Performance" (May 1998), the author emphasized the importance of performing patient surveys but not staff surveys to evaluate physician performance. I would argue that staff surveys are critical to any physician evaluation and that patient surveys of satisfaction with their physician are not only over-rated but probably useless.

In lay studies that have asked individuals to assign approval ratings to different professions, physicians in general have been rated lower than one would have expected. The interesting thing, though, is that individuals tend to exclude their own physicians from the low rankings.

In patient surveys that I have done, I have found this to hold true. Physician approval ratings fluctuate within a very narrow range. I attribute this to a "trust" factor. After patients have made the decision to commit their care to an individual physician, they place their trust in that physician. Because of this commitment of trust, patients will generally rate the physician in a reasonably consistent and favorable way. If patients cannot place their trust in the physician, they tend not to be patients of that physician.

Staff members, on the other hand, are much more objective on the strengths and weaknesses of the physicians they work with. They have had a chance to see us interact with many patients on many levels, and they are affected by our idiosyncrasies, and our egos. Staff satisfaction is essential to the success of any practice. As much as we might hate to admit it, staff members make generally good assessments on the quality and consistency of our practice.

Robert L. Cranfield, MD
Nashville, Tenn.

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.

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