Experts point to value of physician-patient communication

While CMS and others look to curb the overuse of expensive and potentially risky advanced imaging procedures, the healthcare industry has begun to place renewed emphasis on physicians' oldest diagnostic tool: physician-patient communication.

The trouble is, though, that physicians are not reimbursed nearly as much to use their ears as they are to order a CT scan.

But Wendy Levinson, MD, chair of the department of medicine at the University of Toronto, says that physicians' complicated conversations should be reimbursed as complicated medical procedures, according to an article she co-authored in the July issue of Health Affairs.

CMS points out, however, that when appropriate, there are codes that can be used to pay for the time a physician spends with a patient or caregivers discussing the patient's condition and other concerns during face-to-face encounters. Recognizing that physicians may not be aware of these options, CMS published a 2009 Caregiver Initiative guidance that says physicians seeking reimbursement may spend as much as 25 minutes counseling a patient and family out of a 40-minute visit, Ellen B. Griffith, spokeswoman for CMS, told HealthLeaders Media.

Nonetheless, Levinson argues that more communication time should be considered by CMS for payments, particularly in relation to certain illnesses, and that physicians should be reimbursed for undergoing ongoing training to improve their communication skills.

"If it [were] tied into the whole patient-centered medical home, it can be a vehicle, a new mechanism for paying physicians," she told HLM. "It could be linked to the patient centered care, for complicated conditions."

In the meantime, the Medical Group Management Association offers physicians advice for optimizing their communication with patients under the current reimbursement environment. Among other strategies, MGMA recommends physicians encourage patients to ask questions, adopt an EHR (and integrate it into conversation) and offer patients secure Web messaging with their doctors.

To learn more:
- read this HealthLeaders Media piece
- see the abstract in Health Affairs
- check out this MGMA e-source article
- here's a related MGMA blog post

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