We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Viewpoint |

Time-Based Billing What Primary Care in the United States Can Learn From Switzerland

Kevin Selby, MD1; Samuel Edwards, MD, MPH2,3
[+] Author Affiliations
1Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
2Section of General Internal Medicine, Veterans Affairs (VA) Portland Health Care System, Portland, Oregon
3Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, Oregon
JAMA Intern Med. 2016;176(7):881-882. doi:10.1001/jamainternmed.2016.2230.
Text Size: A A A
Published online


This Viewpoint examines the time-based billing system of Switzerland and makes recommendations to improve the US health care system.

I slipped into the small conference room and quickly understood the topic of the day: billing. “Now with the complexity of our patients, most of our visits should be level 4s. Level 4 visits are for established patients that require complex decision making. Remember, you will need to document either a detailed review of systems or physical exam to bill for a level 4,” the clinic director was explaining. My colleagues were mostly catching up on emails and laboratory results, only partially listening, and focused on their clinical work. I looked at my schedule; I had nearly all 15-minute visits ahead of me that day, and my first patient had already checked in late. Regardless, that afternoon in the 32nd minute of a “15 minute appointment” with an 82-year-old woman that required a cognitive assessment and comprehensive medication reconciliation, I made sure to perform the required physical examination, as the alternative, a 9-point review of systems, was not feasible. In my note, I documented my examination and a sufficient number of stable chronic illnesses to bill for a level 4 visit. It seemed normal that my scheduled visit time was inadequate and that I needed to justify billing by meeting elaborate requirements unrelated to my patient’s needs.

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections