I’ll make this one very short. The same realities apply in the CMS documentation, coding, and billing rules that incentivize over-treating as they do for over-testing.
If I see a patient with a cough, I don’t prescribe antibiotics, and I give the long speech explaining why they don’t need antibiotics, and I reassure the patient that he is doing everything right — just be patient, chest colds can last up to a month — Medicare says that’s worth about $40 ($28 for Medicaid). If I prescribe antibiotics, now that visit is worth $100, if I jump through a few more documentation hoops, which means I write down a bunch of meaningless details that serve only to appease Medicare. They clearly don’t improve the quality of care.
It’s all so wrong.