E&M: The latest rattlesnake

The Health Care Financing Administration recently presented their latest draft version of Medicare's proposed Evaluation and Management (E&M) Guidelines.

The E&M guidelines are ostensibly a set of documentation standards by which HCFA and its agents can evaluate a physician-patient encounter in order to determine whether the billed services arising from that encounter are legitimate.  Previous versions of the proposed E&M guidelines were so arcane, convoluted, and impossible to follow that HCFA was forced to withdraw them, and come up with a "simpler" set.  This latest release represents the results of that effort.

Physicians viewing the new proposed guidelines for the first time remained wary.  The guidelines are significantly simplified, but are still so complex as to greatly complicate each and every patient encounter. And what, exactly, these documentation guidelines require the actual medical record notation to look like is entirely unclear.  

Unable to answer this question directly, HCFA has offered to come up with a set of "vignettes" aimed at providing examples of how the guidelines are supposed to work.  The "vignettes" themselves are expected to be difficult to develop, and will be hashed out in a series of meetings expected to take months.

HCFA also plans to test the new guidelines in a pilot study.  But HCFA does not intend to grant immunity from prosecution to physicians volunteering to take part in this pilot study.  Physician members of the E&M task force have allowed as how the pilot study will be rather small if they don't grant immunity.

DrRich comments:

Doctors are correct to poke around at these guidelines from a distance, as if poking a rattlesnake with a stick.

We have already shown how the E&M guidelines have all the earmarks of an entrapment scheme.  A doctor's every instinct tells him/her that, while some of the stink has been scraped off this latest set of guidelines, there's still plenty of opportunity for harm.  The underlying motive here is not to improve patient care (since, as we have pointed out, such guidelines can only detract from patient care).  The real motive is to provide a regulatory basis for prosecuting doctors for fraud. (Or more correctly, to intimidate doctors with the threat of fraud into underbilling, or even withholding care.)  We find it telling that HCFA remains so anxious to open every avenue for fraud prosecution, they're not even willing to grant immunity to the physicians who volunteer to test the new system.

07/29/2000

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