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Ari Geller<\/p>\nAri Geller<\/p>\n
Like many medical students, I had a difficult time choosing my specialty.<\/p>\n
I vacillated between a surgical, more procedure-oriented field and one focused on medicine. In 2003, and probably still today, the surgeons seemed \u201ccooler\u201d \u2014 learning complex procedures and bragging about them, while we rounded for hours on multiple organ systems.<\/p>\n
It wasn\u2019t until I was mentored by a nephrologist at St. Barnabas Hospital in the Bronx that I was converted. He exemplified the old example of a true clinician, in the tradition of the famous Dr. William Osler, who was one of the four founding professors at the Johns Hopkins School of Medicine and is known as \u201cthe father of modern medicine.\u201d<\/p>\n
Like Dr. Osler, my mentor took his time with patients, generating a detailed history, conducting a thorough physical, and invariably arriving at the correct diagnosis. Back then, I thought nothing of the time he spent doing so, because it delivered better patient care.<\/p>\n
Twenty years later \u2014 at my small, private nephrology practice in Bloomfield \u2014 I practice much in the same way as my mentor did. Caring for patients requires patience.<\/p>\n
Until recently, practices like ours were reimbursed by insurance companies for the evaluation and management of our patients in a way that at least partially recognized the time we spend on delivering care. That makes sense.<\/p>\n
However, health insurers have rolled out new policies that effectively render patient care to a series of letter and number codes. This practice will not serve our patients well and undermines the health of independent practices.<\/p>\n
As a result, my practice supports Senate Bill 342, which recently passed out of the General Assembly\u2019s Insurance and Real Estate Committee. This would end the practice of using AI or algorithms to systematically \u201cdowncode\u201d higher-level evaluation and management (E\/M) claims, a practice that reimburses health care providers as if they were performing simpler procedures that require less time to address.<\/p>\n
Downcoding effectively rewards physicians who see minimally complex patients, and punishes practices that are more cognitive, placing us under greater stress to survive. It also increases administrative costs as we appeal downcoded claims, if we can even spot them, because insurers may not inform us that they\u2019ve even done this.<\/p>\n
The difference in reimbursement may only amount to around $40 on average, but when averaged over multiple visits, it can easily amount to $45,000 per year, per physician.<\/p>\n
Health insurers argue that this new policy will prevent waste and abuse and reduce inconsistent documentation. They also say their new AI tool will only target those on the extreme end of the billing bell curve. Not so.<\/p>\n
The health of our patients is paramount, and many of us spend hours on documentation and calling patients and families, unrelated to time spent face-to-face with our patients. Further reducing the reimbursement for complex patients is both demoralizing and unnecessarily punitive \u2014 especially in a state with rapidly rising costs, and where it is increasingly difficult to recruit new health care providers.<\/p>\n
In 2025, 42% of nephrology training programs did not fill, and 27% of fellowship positions went unfilled. Surveys among medical residents show lack of interest in nephrology, and other similar fields, due to concerns about lifestyle and reimbursement.<\/p>\n
Downcoding only fuels that fire and will drive more physicians out of private practice, further limiting patient choice.<\/p>\n
There are better ways to improve billing accuracy than pre-emptively cutting legitimate claims for our complex patients. Collaborative audits and physician education would be a much better method than the \u201cpunishment by default\u201d of downcoding.<\/p>\n
This is why Senate Bill 342 must pass. When a physician\u2019s time is treated as negotiable, everyone loses.<\/p>\n
Ari Geller is a physician with Greater Hartford Nephrology LLC and a board director and member of Southern New England Healthcare Network.<\/p>\n","protected":false},"excerpt":{"rendered":"Ari Geller Like many medical students, I had a difficult time choosing my specialty. I vacillated between a…\n","protected":false},"author":2,"featured_media":186876,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[38],"tags":[128,9,24,63,129,131,130],"class_list":{"0":"post-186875","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-the-bronx","8":"tag-bronx","9":"tag-new-york","10":"tag-new-york-city","11":"tag-nyc","12":"tag-the-bronx","13":"tag-the-bronx-headlines","14":"tag-the-bronx-news"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts\/186875","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/comments?post=186875"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/posts\/186875\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/media\/186876"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/media?parent=186875"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/categories?post=186875"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/us-ny\/wp-json\/wp\/v2\/tags?post=186875"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}