Letters

Practical coding help

To the Editor:
Your question and answer titled "Prolonged labor and a C-section" in the Reimbursement Strategies section of your September 1998 issue has made the most significant improvement in my obstetric billing of any article or book I have read. I did not know I could bill separately for the history and physical or that I could bill for assisting at the C-section.

Please keep printing straightforward and practical coding and billing information.

H. Coleman, MD
Scottsboro, Ariz.

On physicians, PPMCs and profit

To the Editor:
In "When a Physician Practice Management Company Comes Calling" (June 1998), the consultants made one message very obvious: There is no reason, consistent with the professional goals of family physicians, for a PPMC to buy a primary care office. As Nathan Kaufman said, "The problem is that after you pay expenses and legitimate compensation to the physicians, there's no money left over."

Doctors must remember that in medicine, profit is the fuel; in business, profit is the goal. No PPMC or hospital will willingly allow a practice to lose money or provide less than a constant 15 percent return. Once the goals of the doctors and the owners clash, guess whose goal will be primary.

John J. Messmer, MD
Palmyra, Pa.

Evaluating physician performance

To the Editor:
I agree that patient satisfaction surveys tend to produce physician approval ratings that fluctuate within a narrow range (see "Staff surveys tell more than patient surveys," September 1998, and "Using Qualitative Self-Evaluation in Rating Physician Performance," May 1998). The validity of patient surveys comes when the responses are reproduced from many different patients over time. I also agree that staff members are in an ideal position to assess a physician's activities, but I have two concerns about this.

Evaluations by only a few staff members may be skewed by lack of objectivity (for example, a staff member holding a grudge against a physician, or a staff member being overly loyal to a particular physician). On the other hand, even a truly objective evaluation has its complications, in that it could be misconstrued by the physician and create difficulties in staff relationships.

Like a good marriage, a good partnership, even a good CQI project, productive performance evaluations cannot happen unless all parties are experienced in the give and take of constructive criticism. Until you know your personnel can handle that, it may be unwise to incorporate staff evaluations of physician performance.

Steven C. Flood, MD
Foxboro, Mass.

What's fraud for the goose ...

To the Editor:
Your article on Medicare compliance (July/August 1998) states that the Office of the Inspector General has targeted duplicate claims and resubmission of unpaid claims. Given that Medicare loses claims and that claims status is only available via the Automated Response Unit, which is frequently down or wrong, I don't see how a provider can avoid filing duplicate claims. It seems that the carriers are incorrect as frequently as the providers, but no one accuses the carriers of fraud.

Rosanne J. Hooks, MD
Nichols, S.C.

Not for computer nerds only

To the Editor:
I enjoyed "World Wide Web 101" (July/August 1998), by Gil Solomon, MD. Please follow up with a how-to on Grateful Med and Loansome Doc.

Suzanne Waritz, FNP
Roseburg, Ore.

Editor's note: Look for a new department in our January issue that will be devoted to computers and medical practice. It will address the topics you suggest, as well as offer computing tips for family physicians.

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.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.