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Fam Pract Manag. 2008;15(8):18

Dr. Nancy Ness' recommendation in “A Multiple-Service Rule for E/M Services” [Opinion, June 2008] is simply genius. The implementation is so simple. The reach is so broad. Her plan would go a long way to improve patient care, continuity, comprehensiveness and convenience while lowering cost and complexity. Is anyone at the Centers for Medicare & Medicaid Services listening?

Dr. Ness' suggestion for an E/M rule change makes sense. I am a bit surprised that those looking into containing Medicare costs have not stumbled upon this before. Certainly this was the type of calculus that was used in the days before Medicare and the multiplicity of health insurance plans. I hope this plan gets shared with the appropriate policy-makers.

I recognize it may create “turf” problems in some areas, but if implemented this would improve the remuneration of family physicians who are certainly capable of managing the type of problems presented in the article's example.


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