[sxg]

Many departments do standardize their note formats. The problem is that the note is directly connected to billing, and the billing requirements are absurd. I'm a medical student, and I recently visited my PCP for a medication refill. I have no significant medical history whatsoever, and the visit took no more than 15 minutes as expected. A month later, I was given a bill for $330 stating my hospital visit was level 4 acuity (there are 5 levels, with level 5 being ICU-like care). I looked into how the billing level is determined, and I found this article explaining how components of the notes are tied to billing levels [1]. Basically, by including 6 elements to the physical exam rather than 5, you can bill at a higher tier. There are several other areas that are tied to billing like this, including the family history, social history, etc. My PCP had completely filled out her standardized note to include every little detail I had mentioned—many of which were totally irrelevant to my current issue.

I talked to some other physicians about this, and I learned that hospital departments use their standardized notes to include as much detail (i.e. bloat) as possible so that physicians can bill at higher tiers since billing is tied to the number of details included in the note.

[1] https://www.aafp.org/fpm/2003/0100/p29.html#fpm20030100p29-b...

[corebit]

The reason healthcare costs so much is that the feedback loop between the service recipients, providers, and payees (the largest of which is the Government which multiplies the mismanagement) is so perverse.

[bookofjoe]

FWIW, my psychiatrist calls in my medication Rx (3 drugs taken PO daily) every December, with 11 refills. I've been on exactly the same Rx for 18 years, so it's not as if he's going out on a limb. Sure cuts down on appointments to see him.

[Scoundreller]

Why did a visit to your PCP get billed as a hospital visit?

And which acuity scale was this? Usually the higher the number, the less acute you are.

[sxg]

I meant outpatient visit. My PCP is in the main campus of the hospital, and I wasn’t being rigorous with the terminology.

I’m using the CPT codes within the site I linked to. 99211–99215 are the codes that correlate to acuity, with 99215 being the most acute. I am aware of other systems like level 1 vs level 2 trauma centers. In that case, yes the level 1 is higher acuity. Maybe that’s what you were thinking of?

[Scoundreller]

Got it. I perused the link but didn’t see any 1s,2s,3s,etc. I was just worried that the US started implementing a triage scale opposite from the rest of the world.

I’m more familiar with the (pre-)hospital triage scales in non-US countries: https://en.m.wikipedia.org/wiki/Triage#Canada

[ivalm]

This is pretty unsavory, most visits are billed at 3.