Last night, a few people on Twitter made one last ditched effort to get the word out to anyone who might be attending the AMA Annual Meeting that Resolution 710 could have very negative consequences for pregnant women refusing unnecessary interventions in terms of insurability and finding future care providers. Right around the same time, the AMA site was updated to include the reference committee reports from the day. One conference attendee informed everyone that the resolution had been unanimously voted down.
To read the reports from the meeting, look for “Reports and Resolutions” in the sidebar:
From the Reference Committee G .pdf file on pages 16 and 17:
(21) RESOLUTION 710 - IDENTIFYING ABUSIVE, HOSTILE OR NON-COMPLIANT PATIENTS
Mr. Speaker, your Reference Committee recommends that
Resolutions 710 not be adopted.
Resolution 710 asks that our AMA ask its CPT Editorial Panel to investigate for data collection and report back at Annual 2010 meeting:
1) developing a modifier for the E&M codes to identify non-compliant patients and/or
2) develop an add-on code to E&M codes to identify non-compliant patients.
Your Reference Committee heard limited supportive testimony on Resolution 710. The author stated that the intent of this resolution is to identify non-compliant patients, especially as there is an increasing focus on physician performance and releasing of physician data. Testimony was empathetic to the difficulty in working with non-compliant patients, but expressed concerns in labeling patients and acknowledged a desire to be sensitive to the possible mental health issues of non-compliant patients.
Testimony provided by the CPT Editorial Board stated that the appropriate forum for addressing CPT issues is through the CPT Editorial Panel process, not the House of Delegates. In addition, while there are no codes that exist to identify someone as specifically non-compliant, there are existing modifiers to identify patients who do not comply. For example, Modifier 2P (Performance Measure Exclusion Modifier Due to Patient Reasons) is available to report non-compliant patients. The list of reasons for Modifier 2P include (1) “patient declined”, (2) “economic, social, or religious reasons”, and (3) “other patient reasons”.This modifier is intended to be used with performance measure Category II codes. CPT Category II Performance Measurement codes are intended to facilitate data collection about the quality of care rendered by coding certain services and test results that support nationally established performance measures and that have an evidence base as contributing to quality patient care. These codes describe clinical components that may be typically included in evaluation and management services or clinical services and, therefore, do not have a relative value associated with them. Given that there exists an appropriate avenue to code for non-compliant patients and that this issue should be directly addressed through the CPT Editorial Panel, your Reference Committee recommends that Resolution 710 not be adopted.
For the record, the wording of the resolution (quote below) seemed to be less about noting that a patient declined treatment, which is relevant and helpful in this pay-for-performance climate, and more about venting about how patients are arrogant and demanding with no respect for their doctors, who are getting stressed out and sick from dealing with ungrateful patients. It sounds more like an ultimatum than a resolution.
Whereas, Many patients are becoming more abusive and hostile toward physicians for many reasons not limited to the economy, increasing co-pays and deductibles, unreasonable expectations and demands, a lack of instantaneous cure, arrogance and/or the belief that they “own” their physicians; and
Whereas, There are decreasing numbers of physicians both in primary care and specialties especially in terms of access; and
Whereas, Increasing noncompliance with treatment can reflect negatively on physicians during black box audits by insurance companies and oversight governmental agencies; and
Whereas, Abusive, hostile, and noncompliant patients result in increasing office resources adding to office overhead and added stress on all of the office personnel, which can lead to potential ill health; and
Whereas, The stress of dealing with ungrateful patients is adding to the stress of physicians leading to decreased physician satisfaction; and
Whereas, Any complaint to any oversight investigative regulatory body leads to uncompensated expenditure of time, resources, and monies to defend physicians or the “guilty until proven innocent” principal; and
Whereas, Physicians need to own the data to simplify patient collection and identification to defend themselves as well as alert outside investigating agencies to the potential nature of the patient’s records; therefore be it
RESOLVED: That our American Medical Association ask its CPT Editorial Panel to investigate for data collection and report back at Annual 2010 meeting: 1) developing a modifier for the E&M codes to identify non-compliant patients and/or 2) develop an add-on code to E&M codes to identify non-compliant patients. (Directive to Take Action)