Wednesday, July 29, 2009

The Art part of Health Care Reform?

M.D.: Where Is the Art of Medicine in Health-Care Debate?

Abraham Verghese MD discusses the objective of tying reimbursement to the time involved with seeing a patient. Attempts at this were made with the development of Evaluation and Management coding. (E/M coding). Unfortunately the criteria for these codes do not include many factors in patient management that have no relevant coding measures. E/M coding is strictly limited by body system evaluations, and depending upon the clinical focus are inappropriate. The coding measures have always been insufficient. There are no codes that reimburse for coordinating patient care with other providers, nor for administrative time involved in justifying payments to payers, including medicare.

Everybody’s got something to say about health reform, but nobody’s speaking up for the art of medicine, Abraham Verghese argues today in a column.

Many doctors’ groups and academic medical centers are too deeply entrenched in the business of medicine to speak up for the field’s noblest intentions, writes Verghese, a novelist, Stanford prof and practicing physician.

And he makes a case that a payment system that encourages doctors to practice the kind of medicine that leads to real relationships with patients could be more efficient in the long run: “Our esteemed medical societies and academies aren't speaking for medicine; they are lobbyists, defending their financial self-interests, lining up for or against the latest bill being proposed. Our great academic institutions and our esteemed medical schools have historically spoken for the cause of medicine, but these days many medical schools are more like big companies with complex financial interests in large hospitals and clinical practices. What about the large foundations dedicated to health care, such as the Robert Wood Johnson Foundation or the Kaiser Family Foundation? I think their voices have become more potent as they seem largely free of the kinds of conflicts of interest that bind many of us, but they are not quite the voice of medicine.”

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