David, you and I are saying exactly the same thing. The crucial element is the medical decision making. If I check all the little boxes to justify a level 4 exam for a few issues which are pretty straight forward, which is admittedly easy, then what is left for me on those times where every bit of my training and experience is put to the test?
Now, one answer is to say "Yes, well, those times are not frequent, and if we buff the chart for all those ordinary visits and the bottom line at the end of the year is good, then we can afford to just eat it on the complex visits and accept that we are being cruelly underpaid for being brilliant." But, I find that really intellectually offensive. I am really PROUD when I yank some poor quivering soul back from the edge because I was really competent that day. I want to be recognized for that, and our society uses money to do that. If that nets me only an additional 15% or so over and beyond the encounters when I don't have to turn on my brain, I feel cheated.
I want to be paid appropriately for the day to day stuff. AND I want to be lavished with gold and jewels when I pull of something really cool. If I upcode everything, I cheat myself of that.
