All our family healthcare visits are now billed as CPT E&M Code "Level Four"

Very few people will understand what that subject line means.

The short version is that the way we account for physician services was born broken in 1994 and it is now in a state of advanced collapse.

It can’t go on and it can’t stop.

Don Berwick, the best CMS administrator we’ve ever had (forced out by GOP) said this five years ago:

.. Dr. Donald Berwick, the immediate past administrator of the Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program, said a small portion of the billing increase is likely caused by outright fraud, but in the majority of cases hospitals are legally boosting profits by targeting the vulnerabilities of Medicare’s payment system. “They are learning how to play the game,” Berwick said about the hospitals....

... Berwick, the former CMS head, said patients haven’t changed. What’s changed is the aggressiveness of how hospitals bill. “They are smart,” Berwick said. “If you create a payment system in which there is a premium for increasing the number of things you do or the recording of what you do, well, that’s what you’ll get.”...

See also

• Gordon's Notes: Health care reform. Be humble. Be afraid of the accounting rules. 1/2009. RBRVS. We had such good intentions.
• Gordon’s Notes: Electronic health records and payment increases: It’s not fraud. 10/2012.