I for one, thought this was evident the instant EHR's became available, shortly after the reimbursement system of requiring "bullet points" to establish payment came into being. Once reimbursement became tied to the amount written as opposed to the quality, doctors, being bright folks, adapted quickly. Third party payers view payment as a "zero sum game"; so, naturally, the payment for services in general was reduced as more higher charges were received.
Reality is that each of us should be able to look at what we do, smear the complexity along a ruler, and divide it into real relative value chunks. The elderly man with multiple problems whom we are keeping strapped together with medical duct tape and who requires weekly visits to avoid disaster should be a 99215 every time, even if his family history is irrelevant. The woman who just never got the word that we have nothing to offer for a head cold should be a 99212. What we deserve is a system that pays fairly for an honest billing, not a computer game.
