The University of Chicago Institutional Review Board deemed this economic evaluation to be nonhuman participant research and thus exempt from approval and the requirement for informed consent. We hypothesized that physicians with longer encounters would benefit the most from time-based billing. We then performed sensitivity analyses to illustrate how these billing changes altered the incentives for specialty physicians as well. Specifically, to identify the economic incentives of expanded time-based billing for E/M revenue in different practices, we performed modeling of the expected E/M revenue for a single physician working in a primary care clinic. In this study, we aimed to compare E/M reimbursement for physicians using time-based billing vs MDM-based billing for outpatient visits of varying lengths. Changes to the economic incentives for different visit lengths could have downstream implications for clinic scheduling and patient access. 13, 14 In turn, individual physicians are likely to see different outcomes associated with these changes in billing. However, variations in patient panels and clinic schedules may be factors in different lengths of an average patient visit. 3, 12 Because time-based billing monetizes previously unreimbursed services, it offers physicians an opportunity to increase revenue, compared with MDM-based billing, which still does not reimburse for these services. The 2021 guidelines allow physicians to bill for face-to-face time and for previously unreimbursed time spent on medical record review, documentation, and coordination of care on the day of the patient encounter. 4 However, substantial changes to time-based billing occurred in the 2021 E/M guidelines. Historically, time-based billing has counted only time spent face-to-face with patients. In addition to MDM-based billing, physicians can bill on the basis of visit length. 6, 7, 8 After-hours work is especially common for primary care physicians (PCPs) and has frequently been associated with increased rates of burnout. 5, 6 As a result, many physicians report averaging 1 to 2 hours of unreimbursed, after-hours work daily. 4 However, studies show that physicians spend substantial time doing work that is not explicitly reportable by the E/M system of MDM-based billing, including medical record review, documentation, and coordination of care. 3 Levels of MDM, in turn, are based on the number and complexity of problems addressed at the encounter. 2 Under this system, a Current Procedural Terminology ( CPT) code can be selected to ascertain reimbursement for a given encounter according to medical decision-making (MDM) levels. 1 Within the fee-for-service model, evaluation and management (E/M) services guidelines have been used for decades to establish the level at which physicians can bill patient encounters. In the US, physicians still receive most of their reimbursement for outpatient visits through the fee-for-service model. Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study collection, management, analysis, and interpretation of the data preparation, review, or approval of the manuscript and decision to submit the manuscript for publication. Arnold, MD Scientific Research Prize through the Pritzker School of Medicine (Dr Miksanek). Supervision: Edwards, Weyer, Laiteerapong.Ĭonflict of Interest Disclosures: None reported.įunding/Support: This study was funded by an internal grant from the John D. Statistical analysis: Miksanek, Laiteerapong.Īdministrative, technical, or material support: Miksanek, Laiteerapong. Corresponding Author: Neda Laiteerapong, MD, MS, Biological Sciences Division, Department of Medicine, University of Chicago, 5841 S Maryland Ave, MC 2007, Chicago, IL 60637 ( Contributions: Drs Laiteerapong and Miksanek had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.Ĭoncept and design: Miksanek, Laiteerapong.Īcquisition, analysis, or interpretation of data: All authors.Ĭritical revision of the manuscript for important intellectual content: All authors.
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