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E&M guidelines still don't work; panel says dump 'em

HHS secretary's regulatory reform group targets one of physicians' top Medicare gripes.

By Markian Hawryluk, amednews staff. June 10, 2002.

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Washington -- The federal government has spent nearly 10 years trying to come up with workable guidelines for documenting Medicare evaluation and management codes. It has taken a Dept. of Health and Human Services task force less than five months to determine that they are broken.

At its May meeting in Denver, the HHS Advisory Committee on Regulatory Reform voted 20-1 to recommend the elimination of the E&M guidelines in their current form. The group does not plan to propose an alternative.

The recommendation will now be reviewed by senior HHS officials who must decide whether the agency has the administrative authority to accept the proposal and whether it is willing to do so.

Douglas Wood, MD, chair of the regulatory reform panel, said the committee members felt the documentation guidelines had not achieved their goals, but had created unneeded complexity for physician practices.

"The documentation guidelines that have been used are unworkable, and I think 10 years of effort to try to find one that works is a pretty strong statement that there is something fundamentally difficult or fundamentally impossible about trying to create documentation guidelines for evaluation and management services," Dr. Wood said.

"The fact that no other commercial insurer uses them should be a pretty strong statement that they're probably not applicable anyway," he added.

Dr. Wood also said the guidelines emphasize a physician's clerical talent. "You are rewarded more for your ability to produce the perfect record than you are for your ability to make the appropriate medical decision about what is best for the patient." [...]