The issue of manipulation of reimbursement rules has reared its ugly head in the popular press as well as the latest issue of the Journal of the American Medical Association . As the authors of the JAMA article rightly points out, we are caught between a rock and a hard place. My interpretation however, is that we and our patients are caught in an intricate reimbursement web from which it is unlikely that any winners will emerge.
Physicians bend the rules for a variety of reasons.
They perceive themselves as patient advocates and see their professional obligation as doing what is right for their patient. Pressure to increase output may have inadvertently increased the possibility of gaming by physicians feeling pressed for time. It is gratifying to see from this study that most of the gaming was not done for the benefit of physicians themselves. While gaming may be viewed as doing what is right for our patients, physicians are caught between conflicting demands. We have a legal obligation to honor contractual arrangements regarding reimbursement.