We propose an alternative method to determine the cost of physician's fees and other medical services in a clear and transparent way instead of complicated mumbo-jumbo type CPT system that is being manipulated to generate excess charges. The most important feature we want is the patient should be allowed to actively engage and determine the cost of services he/she wants or receives, ultimately controlling his own medical bill, which any consumer should always do. We offer following concept to replace CPT/RBRVS based methods.

1. Physician fees based on the level of training, years of experience and amount of actual time required with the patient face to face. This will eliminate most of the CPT codes and all the E & M codes completely. There will be one basic visit code for any encounter by a Physician or any other healthcare provider with the patient. This code will allow up to 10 to 15 minutes for a one flat payment. A computer will count any additional minutes and payment will be based on per minute rate multiplied by additional minutes of service. Example: If a basic charge for a particular Physician is $40 and per minute charge is $2. If this Physician spends 20 minutes in face-to-face actual patient care he will get $40 visit fee for first 15 minutes plus $2 for each of the additional 5 minutes and his total payment would be $50. If next encounter were of 30 minutes the payment would be $40 plus $2 per each additional 15 minutes leading to total of $70.
   
   

   YS suggests different pay scale for different providers based on their experience and level of training.

   Example: For midlevel providers, such as physician assistant or nurse practitioner: visit fee of $ A.

   For MD: visit fee A + B.

   For MD with specialty: Visit Fee A+B+C

   It is fair to allow the providers to charge extra fees in addition to proposed charges if they believe their skills and expertise are worth more. Patients will pay this amount out of their pocket. Providers will have to post these extra charges in their office in a visible place so that patients are aware of it and patients will be responsible for 100% of this cost. This mechanism will allow free market spirit in the system.

2. To prevent over utilization by the patients, there will be co-payments for each service.

   Some providers routinely write off Co-Payments to lure patients. Insurance company directly reimbursing the provider the full amount and then bill the patient for the co-payment part will prevent this abuse.

   Patient will carry an electronic card that contains his insurance information and particular demographic information. When patient comes to Doctor’s office he will insert this card in a computer that can verify the information. Each patient room has a computer with software to identify patient’s insurance card (like current credit card system). This computer also has software to determine the time spent by Doctor with patient. When physician enters the room he enters his password of electronic key and then only computer will start to record time. All patient related work that requires doctor’s time, including procedures, reviewing test results and X-rays can be done in the patient’s room. At the end of visit clock is stopped. To prevent any abuse or fraud the software will have security system so that in the absence of patient’s card the Doctor can charge no time. At the end of the day Doctor will download his data to insurance company’s server or to a national system (many of these clearing house services are available nowadays to process claims for multiple different insurance companies including Medicare). Insurance company will send payment to Doctor directly, bimonthly, or monthly as per the agreement. This will completely eliminate the need for expensive, very complicated and corrupt CPT based billing system with a saving of billions of Health care dollars. With a National clearinghouse it can also be made possible to keep track of total time any provider can charge per day. Currently a provider can charge for more than 12 hours worth of CPT codes (by creating enough paper work) while actually he may have worked much less than 12 hours. Unfortunately, this type of abuse occurs routinely and time clock system will eliminate it completely.