The challenge of successfully running a physician private practice has never been greater, given the strains of the continuing COVID-19 pandemic, inflation, staffing shortages and more.
The free AMA Private Practice Simple Solutions rapid-learning cycles help physicians seeking to flourish in private practice by offering pre-recorded webinars and message boards that offer opportunities for participants to interact and to submit questions to the experts who present during the webinars.
“We want to learn from each other … and I’m really excited to learn with you and from you,” said Jeannine Z. Engel, MD, an AMA member and a University of Virginia associate professor of medicine, who presented during “E/M Documentation and Coding: Update for Ambulatory Visits.” The first webinar in this learning series covers outpatient evaluation-and-management (E/M) guidelines and related Current Procedural Terminology (CPT®) codes.
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In addition to the webinar and discussion board, there is an AMA STEPS Forward® Simplified Outpatient Documentation and Coding toolkit, which helps private practices:
- Understand guidelines.
- Engage key players.
- Design workflows.
- Educate physicians and staff.
- Use the new E/M codes.
The E/M coding-and-documentation reforms began in 2019 with the Centers for Medicare & Medicaid Services (CMS) issuing a rule allowing physicians and other qualified health professionals who bill E/M services to use the documentation on a patient’s history of present illness and past family social history that was entered by nurses, nursing assistants, scribes, students or the patients themselves.
“The goal of these changes was to reduce redundancy and the documentation burden for the physicians and qualified healthcare professionals,” Dr. Engel explained, adding that many EHRs have built-in workflow functions for this purpose, but they may need to be activated.
More changes came in 2021, including the flexibility to select a level of service based on the complexity of medical decision-making or total time on the day of service.
The changes were designed to reduce the administrative burden for documentation and coding, lower the need for audits, and cut unnecessary documentation in the medical record that was not needed for patient care, said Dr. Engel, an internist who serves as the American College of Physicians’ adviser to the AMA CPT Editorial Panel.
Dr. Engel provided a sample of CPT E/M codes with the number of relative value units assigned to them by CMS and the fee that physicians receive for those services in her home state of Virginia. She also linked to a CMS resource (PDF) that physicians can use to determine the fee they will receive for that service in their state.
Dr. Engel described how the level of medical decision-making—either straightforward, low, moderate or high—was based on using two of these three elements:
- Number and complexity of problems addressed.
- The amount and complexity of data that needed to be reviewed and analyzed.
- The risk of complications or morbidity and mortality stemming from patient-management decisions made at the visit.
For further assistance, Dr. Engel pointed to a 28-page CPT document (PDF) that describes patient-presenting problems in more detail and assigns levels of severity.
“This does make it a little easier for us to determine where our patients fall within these different levels of service,” Dr. Engel said.
Two elements were added to rubric used to calculate risk in medical decision-making and are included in the “moderate” column. They are prescription drug management in the patient encounter and “diagnosis or treatment significantly limited by social determinants of health.”
It takes astute clinical judgment as well as a commitment to collaboration and solving challenging problems to succeed in independent settings that are often fluid, and the AMA offers the resources and support physicians need to both start and sustain success in private practice.
Learn about the AMA Private Practice Physicians Section, which works to preserve the freedom, independence and integrity of private practice.