I dont think anything will change until Dr Jayne and others take my approach of naming names, including how much…
EPtalk by Dr. Jayne 9/4/25
In the spirit of “no good deed goes unpunished,” insurance giant Cigna Healthcare creates a new reimbursement policy that adds additional scrutiny for certain high-level evaluation and management codes, which could lead to those visits being downcoded.
We saw this type of review during the early days of EHR adoption, prior to Meaningful Use. Physicians began using the power of the EHR to more accurately document the work they had been doing, but perhaps not documenting as well as they could have. When practice management systems picked up on that additional documentation to suggest higher billing codes, there was a bit of backlash in some parts of the country. Fortunately, my health system had a detail-oriented coding and compliance department that was willing to go to the mat for our physicians, so we didn’t see much negative impact.
I wonder if this is partly being driven by increasingly detailed documentation that is being generated through ambient documentation systems. I am curious if organizations are changing internal revenue cycle management policies to get ready. Feel free to reach out if you’re doing something different to prepare for this or if you feel targeted.
With recent changes to federal vaccine recommendations, some professional and clinical organizations are coming out with their own guidelines, including the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.
It used to be easy to pick the guidelines that would be used to inform your EHR’s health maintenance and vaccine reminder features, but things just got a little trickier. I’m interested to learn if organizations will be incorporating these varied guidelines or instead will stick with the revised federal guidelines and leave physicians to shoulder the cognitive burden of remembering the other guidelines.
Sometimes I see headlines that don’t make sense. This one from CMS promotes its “Crushing Fraud Chili Cook-Off Competition.” I went to the linked website to see if it helped me make sense of it. I get the cook-off analogy (or bake-off, as some describe it), I don’t know why they doubled down on the “chili” aspect, which is also included in the challenge’s logo.
The competition is designed to identify ways to reduce labor-intensive processes. As someone who has cooked a lot of chili in her life I wouldn’t define it as a particularly challenging dish. I guess “steel cage match” didn’t resonate with the CMS folks, but it would draw more attention than a chili cook-off with no chili.
I’ve been in healthcare a long time, but somehow I missed out on this annual Most Beautiful Hospitals competition. The 2025 winners that were announced this week range from pediatric subspecialty to critical access hospitals. I’m sure people prefer to get their care in places that are aesthetically pleasing or provide a more healing and recuperative environment, but based on my last few care encounters, I would settle for one that has decent wayfinding and communication that go beyond the bare minimum.
From AI Troll: “Re: Taco Bell. It is using AI in its drive-throughs.” The piece details the issues the company has had in trying to implement AI-powered voice ordering. It has been used at 500 locations, and although some implementations have been successful, others have been challenged by people placing wildly inappropriate orders such as 18,000 cups of water.
I used to work at a healthcare facility that was next door to a Taco Bell. I saw many orders being placed by our paramedics and other support staff. The franchise couldn’t even get orders right with humans in the loop on both sides of the order, so I don’t have a lot of confidence that AI would be helpful there. I would personally rather order through an app than argue with interactive AI, but then again, I’m not the demographic that Taco Bell is likely looking for.
From Mascot Wannabe: “Re: health systems and stadium naming rights. Here’s a weird one.” People have spotted stickers around Chattanooga, TN that promote the naming of the new minor league baseball stadium after Erlanger Health. However, the health system denies being behind the stickers, which say, “We bought the best baseball stadium naming rights in Chattanooga” and feature an outdated Erlanger logo.
The health system’s CEO is quoted as saying that it’s “an investment that’s going to have a create return for Erlanger and the community,” but I haven’t seen anyone quantify the ROI of such deals. If you’re in the know, feel free to reach out anonymously.
Turning to a non-tech topic for a change, this BMJ Open article on physician attire caught my attention. The authors did a systematic review of patient perceptions of physician dress to see if it impacts the physician-patient relationship. They identified studies that were published from 2015 to 2025. They found that patient preferences varied based on specialty, clinical context, and physician gender.
Some studies have found that combining casual dress with white coats may signal approachability in primary care and ambulatory settings. Scrubs were favored for emergency and operative environments, where they signaled preparedness and professionalism. Male physicians were perceived as more professional when wearing formal attire with white coats, while female physicians in similar attire were often misidentified as nurses or assistants.
I recall a dustup in a large California-based integrated health system a while back. A new OB/GYN department policy specified that female physicians must wear “hosiery,” but had no similar recommendation for males. Administrators couldn’t justify the change since unspecified hosiery isn’t considered personal protective equipment. If they had a Victorian aversion to bare ankles, it would have made more sense to require coverage with clearer language. Physicians responded by wearing silly socks to prove a point, and the policy quickly vanished.
What do you think defines professional attire? Should physicians consider ditching the white coat or keeping it for historical value? Leave a comment or email me.
Email Dr. Jayne.
I’m outraged that Cigna will be scrutinizing level 5 E&M. I’m also outraged that this is necessary. ProPublica has researched this issue multiple times – https://www.propublica.org/article/some-doctors-still-billing-medicare-for-the-most-complicated-expensive-office-visits
I’m hoping that Cigna soon realizes that their costs for the increased scrutiny exceeds their savings. But I worry that the over coding physicians are so many that Cigna realizes they need to apply more scrutiny, and this policy expands to other payers.
The question of value from sports sponsorships is interesting. Many don’t get value because they don’t put in the work. These 2 articles by Clay Allen highlight some of the details of how healthcare organizations can get value from sports sponsorships: https://swaay.health/tag/clay-allen/
Also, the most beauitful hospitals list is interesting especially given Judy’s call at Epic UGM for hospitals to be more colorful. She showed the pediatric hospitals that are colorful, but the adult hospitals aren’t and challenged people in the audience to invest in more color cause Adults like color too. She hoped to share pics of changes at next year’s conference. I’m interested to see who takes her up on it.
I prefer prompt, courteous, competent, professional care. I could care less what the doc wears.
Re: “professional” attire
1) I agree that “hosiery” as a requirement for women is sexist BS and should never have made it outside the four walls of the “employee handbook committee” meeting.
2) Personal archetypes are wild. I grew up in an area of the country that has a large lesbian population, and I grew up around a lot of very tomboyish women — the ladies who ran my daycare center, the moms in my friends’ two-mom households, my first non-pediatrician physician, the women I would see in every day life walking around town. I had a sick visit recently and my regular PCP was not available so I saw the NP, and she walked into the room in a t-shirt and slacks, with a high and tight haircut and a baseball cap and my *immediate* reaction that I felt down to the atomic level was “this woman will take good care of me”, and I switched my PCP to her. No “professional” medical attire — dresses with hosiery and heels, pantsuits, white coat, whatever — has ever given me the same level of comfort and relief that she did.