E&M

By request (check the comments), here is the latest Pediatric E&M Distribution data from PCC. You can't get it much fresher than this - a few million E&M CPT codes, from May 2007 to May 2008. I had a good, in-depth, analysis earlier this year.

A note over on an MGMA mailing list reminded me that I haven't done any good benchmarks in a while, so why not quickly publish our latest pediatric E&M distribution results. Here's a comparison of PCC's pediatric E&M distribution, 2007 vs. 2003, when we started pushing our clients on this issue...

 

For those scoring at home, the data:

While I'm mentioning samples from my seminar collection, here's something I just received from PCC's coding Igor (ette). She was at a local E&M coding conference and reported this tidbit:

Comprehensive exam is defensible for Medical Necessity simply by virtue of being a peds exam (developmental component not present for other specialties), by exploration of mechanism of injury, systemic/chronic disease involvement.

A much more eloquent (and concise) way of putting something I've been trying to say for years.  When I discuss pediatric E&M distribution, I often find myself fighting the perception among pediatricians that pediatric visits aren't complex - it's easy, kids' stuff.  "Adult medicine, especially with all those chronic conditions and crazy medications...now that's complex."  I don't buy it.  Why?

• Nearly every pediatric visit has a layer of communication complexity simply not found in other specialties.  Many of your patients can't even talk!  Usually, though, you have to translate something a parent says and balance that against what you are seeing...and balance that against what the patient tells you.  That's easy for pediatricians, but not for someone who hasn't been trained and does it every day.
• You have developmental issues.  Every well visit is an acute visit waiting to happen.  Every acute visit is a chronic diagnosis in disguise.  The example I always used to give was a simple sore throat - don't you always check a dozen other developmental issues while you're at it?  I thought the language above made and excellent point.

Gosh, a guy makes a couple statements in a blog and now people actually want him to explain the numbers so that they make sense. There's no satisfying the mercurial reader any more. My word isn't good enough?

Actually, my apologies for some confusing data. Let me explain yesterday's post in more detail and, perhaps, add some information. Igor and Susanne Madden pointed out that I accidentally cut off the Y-axis label/Title (d'oh!), which makes it confusing.

I decided to measure the average E&M reimbursement for PCC clients in a different manner than Physician's Practice for a variety of reasons.

• First, they use absolute dollars and not a specific year as a yardstick. I think this makes it difficult to actually gauge any changes in relative terms without looking closely at the graph (and then guessing what the values really are) and then doing some math in your head.. If you look at their first graph, for example, Middle Atlantic seems to have gone from a $90 to a $70 average E&M payment, more-or-less, from 2004 to 2007. Wouldn't you rather know that this is a 28% decrease? I would, I guess.
• Second, from what I can tell, PP doesn't take the code volume into account. That is:

CPT
Volume
Reimbursement

99213
10000
$100

99215
10
$500

...is the average E&M reimbursement here about $100.39 or is it $300? I say it's $100.39, and I think PP lists it as $300.

Therefore, the numbers from yesterday look at overall "average E&M reimbursement" and use 2004 as a base year for measurement. In our data, the Middle Atlantic group has seen their E&M reimbursement improve 16% since 2004 (vs. an estimated 28% decrease in the PP data).  I also took some care to make sure that the scale of our graph resembled theirs so that, even though we measure things differently, they approximate a similar message with different results.  The bottom line?  PP continues to measure a downward trend in E&M reimbursement and we measure an upward one.  Which is correct?

I've updated the graph so that the explanatory title is back.

More in a bit.

Physician's Practice magazine has released, both in print and on-line, the results from their annual Fee Schedule survey. On one hand, I continue to applaud PP's effort. On the other hand, their data continues to diverge from ours considerably. In effect, the fortunes of PCC customers continue to rise while those of PP contributors continue to fall. Is it sample size? Are our clients simply doing that much better than the rest of the world? Does PP measure things different (and somewhat oddly)? I suspect it's a combination of all of the above.

Let's see how the numbers compare. There's so much here that I'll have to split it into a few blog entries, I suspect. Let's start with the big piece, the drop in E&M reimbursement. From the article:

Sorry, but the news is no better today. In fact, it’s disturbingly similar: Another sizeable drop in E&M visit reimbursement.

Here is a quick snapshot of their E&M details:

If you want a closer view, you can find their PDF here.

I took the time and made a similar chart for our clients over the last four years. Check it out. It took me a long time to figure out how to lay this out, so applause is welcome :-)

You'll note that we have a distinctly different pattern of behavior over the last four years. While Physician's Practice magazine reports a distinct negative trend in E&M reimbursement, PCC clients are improving.

In the next day or so, I'm going to zoom in specifically on pediatrics and their results. Anyone here seeing different results?

Last week, Igor and I were looking at the usage of -25 Modified E&M codes as the information about them is a bit of an unspoken subject in our business. I can't find any good, definitive sources so, as usual, we have to create our own.

Need proof that this is the best pediatric practice management resource on the planet? Check it out.

 

Oh, first: major drama at PCC's office last night. Let's hope this post is the closest I come to being a war correspondent. I don't like the proximity of the event to yesterday's message about flooding.

 

I've had a request to post some information about the 2008 RVU impact, but I've decided to wait a day or two for the dust to settle about the latest news. Hope you don't mind.

We've been working on it for a long time (toooo long), but we are just about to officially release our Practice Vitals Dashboard service to PCC customers.

"Dashboard?" you ask. "What's a dashboard?"

You'll know them as soon as you see them. In fact, here's a quick sample of a piece of one:

This is a quick snapshot of just the initial graphical display of one of six benchmarks we hope to display to them at first (Revenue-per-Visit, E&M Distribution, RVU-Per-Visit, Pricing, Sick-to-Well ratio, A/R Days). The example above shows that the E&M distribution for this sample customer is 18.7%, putting them at the lower end of the "Good" scale.

Each of the benchmarks, like the one above, is "clickable" for more detail. Thus, you could log into pcc.com using your special login and would be immediately presented with your most important management measurements, complete with detailed explanations of the benchmarks, comparisons to other pediatricians around the country and in your region, and an historical view. It's really cool to click on a PCC customer and watch their Revenue/Visit rise every year. Actually, here's what it looks like!

Pretty cool, eh?

I mention all this for a couple reasons:

• We are going to make some very simplified versions of these benchmarks public as part of our new pediatric resources WWW site (more about that later). You won't be able to find this information anywhere else.
• P CC customers will have access to more than I am describing here - super cool.
• PCC customers who are also part of our "Practice Advancement Plan" will receive the Advanced Practice Vitals Dashboard, which will include many more benchmarks as well as the ability to drill down like crazy. You want to know your RVU-Per-Visit for Doctor X in 1999? Click it!

Obviously, all of these reports are available in our system and our clients can run them at any time on their. This service exists for the majority of physicians who don't have the time or inclination, however, to do that. We think it will go over pretty well!

Any suggestions for benchmarks welcome!