LEVELS of SERVICE based Fee Schedule / Development of Real Evidence Base

[Guest guest]

Theoretically, a fee schedule based on LEVELS of SERVICE allows

maximal flexibility in providing for disparate income levels. It is

also conducive to proper Evaluation and documentation, which can add

to REAL Evidence Base.

 

This is NOT a sliding scale. It is FIXED, unless you decide to modify

it tomorrow, (in which case just give advance notice at time of

scheduling or walk-in.) It can range from ZERO dollars and zero cents,

up to about a gazillion and one.

 

For the wonderful client who wants to pay ZERO, you could (for

example) try to be a nice person, maybe with some weakness, but not

necessarily kindness (that's a joke). This would be based on

face-time or phone-time of a couple of seconds. If you enjoy the

encounter, you may choose to share / donate SOME AMOUNT of additional

time / effort, etc., on a COMP (complimentary) basis without any

additional charge. No one can compel you to donate equally to

everyone, unless of course you fall under various restrictions

(non-profit, government sponsored, applicable existing contracts, etc.)

 

For about a gazillion and one, the full extent of your offerings can

be made available for the remaining duration of your public life.

 

There are a few LEVELS of SERVICE in between. Actually, there are as

many DIFFERENT LEVELS of SERVICE as there are UNIQUE client-patient

STATUS / ENCOUNTERS, which is probably a big number.

 

Time spent, complexity of the case, difficulty of decision-making,

ETC., are ALL factors that reasonably allow you to slot what you do to

best meet the needs of all concerned.

Before OR after the fact. (If you don't believe me, just try to ask

any hospital or most physicians if they can predict exactly what they

will do / charge before they start!)

 

CPT is a good thing to learn and understand. It is owned by AMA. It

is not law. You are not bound by it. You can invent your own codes.

Or additional digit modifiers. 3rd party payers choose to base their

reimbursement on CPT and always changing UCR data. They will always

try to downgrade whatever you code. You have the right to present

evidence to the reasonableness of your charges, and like many games

the more you understand the better you are likely to fare.

 

IMO it is unsophisticated to not distinguish between Evaluation and

Treatment. Practitioners who offer a one-size-fits-all service . . .

and call it *Acupuncture*, fail to grasp the implications of Usual,

Customary and Reasonable regional databases, and as a direct

consequence give the world of healthcare the impression that Ac's

offer a very limited simplistic service.

 

Also, when assessment and diagnosis is hidden (because people only

want to pay for treatment), the tendency is to go with quick gut-level

instinct and minimal charting. There are more than few successful

practitioners whose case histories show little to match prevailing

standards of evaluation, and thus little to counter the skeptic's view

of nice anecdotes from charismatic charlatans. This is not about

advocating double-blind RCTs. It's about pre and post assessment with

enough variables eliminated that can clearly demonstrate the effect of

whatever it is that you do. Establishing REAL Evidence-Base should

NOT rely on meta-analysis of a bunch of poorly designed studies done

by people with nefarious purposes.

 

It DOESN'T MATTER that you don't bill insurance. As B. Mosca informed

re: California's B & P Code, Section 657 supposedly prevents DISCOUNTED

fees from being deemed THAT provider's UCR. However, when the MARKET

RATE is driven down to dismal lows, the damage is done. What you do

becomes part of community standards, and the fact is that those

standards have been seriously diminished over the last 15 or so years.

 

[ I will need to follow-up this article with a postscript pertaining

to what may have been entirely covert maneuvers a couple of years ago

to subsume most Evaluation and Management services into nominal

Acupuncture codes. Stay tuned ]

 

joe reid copyright 08-2008 All rights reserved

www.jreidomd.blogspot.com