Opinion
Referral rule change not in sync with real world of medical practice
LETTER — Posted Aug. 13, 2007
Regarding "Rule changes for referral documentation create confusion" (Article, July 9): This is one more nail in the coffin of medical quality.
The U.S. is suffering in quality of care by several reviews. Are the rules noted going to improve quality?
In our community, I feel we have a very good set of specialists, with some areas covered by more than one specialist or group of specialists. My goal is to have the patient seen by the first available specialist who accepts Medicare (Thanks for your rules, CMS, but some are saying no to assignment now -- wonder why?). At the point of care, when I make my referrals and indicate the reason, I do not know who the referral staff will find to fulfill my need. If I have to do as indicated [by one expert quoted in the article], that is, specify the name of the specialist and not just say referral to cardiology, for example, the task of creating referrals becomes another process to track.
I think that it would be very good for real doctors in real practices, practicing evidence-based medicine, to begin to make real rules that we can function under. Practicing in the real world would help them to formulate standards they themselves, as full-time harried physicians, can understand, comply with, and work across the board for all insurers.
I, for one, am seeing administrative physicians as living in a fantasy world of ideals rather than practical steps, as not communicating with administrators of other insurers to coordinate requirements and to track how all of these rules are being managed by physicians.
Paul Nault, MD, Prescott, Ariz.
Note: This item originally appeared at http://www.ama-assn.org/amednews/2007/08/13/edlt0813.htm.
