Readers React

Code at the proper level

As a pediatrician new to the art of coding, I enjoyed reading "Watch out for EHR audit pitfalls" [Apr. 20]. Although we do not have an EHR yet, I found it interesting that the same warnings not to overcode apply.

In the article you point out an internist who was coding a substantial number of 99214s, and imply that this would be an anomaly. I disagree. To meet that criterion with complex patients would not take much; and to use a template or EHR to ask the required elements would not be difficult. Along these same lines, to make the medical decision-making moderate, a patient would only require two chronic conditions that are stable or one acute illness with systemic symptoms, and then prescribe medication or make a referral.

Unfortunately, coding has become a game where the insurance companies make the rules. The key is learning how to win at their game.

Dave Smith, MDSt. Cloud, MN

Online booking makes sense

In "Online appointments? Doctors say no" ["Update," Apr. 6], you say that doctors don't want to let their patients make online appointments. I think that DoctorsDirect is just too expensive. I have been using AppointmentQuest for the past two-and-a-half years and love it. Many other doctors I have talked to in small or solo practices also use it. It's only about $30 to $40 per month.

There are so many of my patients who make their appointments online, that we need only one person at the front desk of our busy two-person family practice group. And since every patient gets an e-mail reminder the day before their appointment our no-show rate is low.

Larry Lindeman, MD Chicago

Take action against retail clinics

In "Retail Clinics: Better plan your strategy now" ["Memo from the Staff," Apr. 6] you point out how primary care physicians can compete with retail clinics by providing what the customer, our patient, wants. I agree with your commentary up until you state: "In the end, it's not your reaction to retail clinics that counts; it's how you adapt. . . ."

Over the past few years, physicians have had numerous negatively impacting changes thrust upon us by those we do business with-health insurance companies. Our overall response has been to "adapt" by squeezing in more patients per hour while earning less and using lower-cost nonprofessional providers. As a consequence, job satisfaction is rapidly waning for me and my colleagues. While we need to adapt to our customers' needs, we really must start reacting more to our business needs.

Up to now, pharmacies have relied on us to send business their way. And now they want to bite the hand that feeds them? We send patients to X-ray facilities, specialists, physical therapists, etc., and if they began openly competing with me I would "react" as most would by steering patients away from them. This situation should be no different.

Cary D. Douglass, MDAustin, TX

Religion and patients

As a practicing geriatrician, I thoroughly appreciated the debate and conundrum over religion in medicine that was enunciated in "Religion in the exam room: Does it belong?" [Apr. 20].