WHEN funding fails, regulations thrive. Regulations depend on information, and the more detailed the data, the greater the potential for use or abuse. Understandably, physicians are ambivalent about cooperating with the Health Care Financing Administration evaluation and management documentation guidelines.
Dr Busis advocates cooperation, pointing out that the guidelines are a local extension of the Resource Based Relative Value System, in use by Medicare since 1992. As a cognitive- rather than a procedure-oriented specialty, neurology stands to gain from such a system. Dr Williams points out that the reimbursement schedule has not kept up with the costs and that "in the 1990s, the quest for savings in health care costs has gone from lean to mean."