News in brief - March 6, 2000

AMA: Stop E&M referrals to inspector general

Washington -- All referrals to the Health and Human Services Office of Inspector General related to evaluation and management documentation should be halted until the Health Care Financing Administration conducts a peer review pilot test of the proposed guidelines within the next six months, the AMA said in a letter to HCFA.

The AMA's Current Procedural Terminology Editorial Panel submitted its proposed revised guidelines to HCFA last June, but a spokesman said the agency was still reviewing the guidelines. HCFA currently allows physicians to use either the 1995 or 1997 E&M guidelines.

"We believe that until HCFA settles on a final set of documentation guidance to the physician community, it should authorize carriers to accept either the 1995, 1997 or 1999 version of proposed documentation guidelines, whichever is easier for the physician," wrote AMA Executive Vice President E. Ratcliffe Anderson Jr., MD.

"The AMA remains extremely concerned about HCFA's approach in auditing physician documentation of E&M services," Dr. Anderson wrote. "The lack of consistency among carriers in applying random audits, the absence of agreement from HCFA itself on what constitutes adequate medical record documentation and the lack of peer review of physician documentation of E&M services leads the AMA to urge HCFA to suspend random reviews of these services."

Washington -- A new study counters the common wisdom that consumers have little choice in selecting their health insurance.

The Center for Studying Health System Change found that 64% of American families offered employer-based health coverage were given a choice of plans -- a 2% gain between 1997 and 1999. Researchers said the amount of choice is larger than commonly assumed, in part, because the study included options available to the whole family when spouses are each offered employer-based coverage.

Policymakers believe that consumers must have a choice in health plans, and detailed information on which to base that choice, to ensure that health care market forces work to consumers' advantage. "Choice of plan is at the heart of whether or not consumers can shape the health system to meet their needs," said Paul B. Ginsburg, president of the center.

The study also shows that plan options increased for workers in firms of more than 50 employees and for those living in small metropolitan areas. But people employed by businesses with fewer than 50 workers often faced a different set of circumstances.

Washington -- The Health Care Financing Administration's new enrollment requirements "will only create additional bureaucratic hassles for physicians," the AMA wrote in a recent letter to the federal agency. The AMA asked HCFA to refrain from including physicians in the new rules, which are aimed at rooting out inappropriate enrollment that could lead to fraud.

Under the proposal, all physicians, not just those who have opened or switched practices, would have to re-enroll every three years in Medicare. Delegates to the AMA's 1999 Interim Meeting said the proposed 17-page enrollment form, with its 12 pages of instruction, would burden physicians.

"Such an expansion for physicians of the enrollment program at this time will only serve to further the divide between physicians and the Medicare program," wrote AMA Executive Vice President E. Ratcliffe Anderson Jr., MD.

The new requirements also may overwhelm HCFA. "The AMA is concerned that carriers and HCFA will be flooded with enrollment information that the carriers and the agency will not be able to process," Dr. Anderson wrote. Already, it can take carriers six months or more to process a physician's request to enroll in Medicare.