Reform payment systems to increase efficiency

We could readily address the shortage of physicians by increasing physician efficiency. (“There are no easy answers to scope of practice debate,” September 10, 2013). The fastest, cheapest, and easiest way to do that is to limit all administrative incentives, concerns, and liabilities of our current billing and payment systems.

I volunteer at a free medical clinic. I probably can see three to four times more patients compared to my private practice because I am not concerned about billing and documentation issues. The focus is on good patient care and documentation required for providing that care.

The other advantage would come from the greater clinical experience. Physicians who care for more patients are likely to be better-skilled and better able to get to the point quickly, and then have the time to educate and discuss preventive measures. 

Physicians who develop good relationships with their patients have better outcomes while spending less. Where do we provide the incentives in our current system for this obvious outcome determinant? Indeed, one could say the incentives/pressures interfere with proper therapeutic relationships. Given the administrative concerns and liabilities involved with not crossing the T’s and dotting the I’s, physicians are understandably stressed.

In Washington State, if a physician makes an error repeatedly in billing or documentation in Medicaid patients they can be charged with criminal fraud. No intent needs to be established. The service provided, however necessary, cost-effective, and professional does not constitute an adequate defense. I wonder how these sorts of liabilities will influence physician readiness to see more Medicaid patients?

 J. Kimber Rotchford, MD, MPH

Port Townsend, Washington