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News and Trends

June 1, 1998
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Software Developers Come Out Ahead

HCFA’S NEW EVALUATION AND MANAGEMENT (E/M) documentation requirements have prompted considerable debate across the entire healthcare community.

Policymakers are targeting physicians in an attempt to retrieve some of the $23 billion lost to fraudulent and erroneous Medicare claims. The new policy, published by HCFA and the American Medical Assocation (AMA) last October requires physicians to provide extensive details on history, examination, medical decisions, counseling, coordination of care, nature of problem and time--all of which will be used to define the level of E/M services rendered and the amount they are reimbursed.

At the same time, practitioners are attempting to defend their livelihood as caregivers--not office workers--claiming time spent with administrative tasks will increase threefold. "The E/M guidelines force physicians to devote inordinate amounts of time to documentation rather than patient care," Neil Brooks, president of the American Academy of Family Physicians said in a speech in Washington, D.C., to the Practicing Physicians Advisory Council, a Health and Human Services advisory committee.

Meanwhile, information systems developers find themselves with an opportunity to finally prove they can make physicians’ jobs easier. "This is a great way to sell a system," says physician Richard Gibson, medical director for the information services division at Providence Health System in Portland, Ore. "Software vendors are realizing new documentation requirements will encourage doctors to use computers."

Gibson’s staff at Providence uses the Logician electronic medical records system from MedicaLogic, Beaverton, Ore., which, he says, does well for documenting encounters. But regardless of what’s automated, E/M requirements will still "take doctors more time," he says.

Some practitioners are less concerned about additional time spent documenting encounters than they are about the stiff penalties--up to $10,000 for documentation errors. The excessive punishment for a physician miscue is unacceptable, says Randolph Smoak, vice chairman of the AMA board of trustees. "The AMA wants to get this softened a bit." Ironically, it was the AMA’s CPT (Current Procedural Terminology) committee that helped HCFA draft the new regulations. However, Smoak explained, the CPT committee has its own agenda and is not controlled by other workings within the AMA.

Many electronic medical records systems are being designed with features such as alerts and flags that warn users when an encounter history or physical, for example, was recorded improperly.

Unfortunately, critics say, the new documentation requirements will invite game playing among physicians--reimbursement based on the number of things they document in the patient’s history. Electronic medical records systems may even contribute to short-cuts in documenting patient encounters, such as allowing a physician to "cut and paste" information from a past visit into the current record.

"My concern is that this could reinforce a bad process with a typical EMR," says family practitioner J. Peter Geerlofs, president and CEO of Medifor Inc., a physician and patient education software developer in Port Townsend, Wash. "The focus needs to remain on patient care." Geerlofs’ company provides formulary software that helps physicians use computers. The company is incorporating documentation and coding guides into its software.

The new E/M regulations could signal a boon for medical record software developers, when the issue is finally settled. After HCFA’s recent announcement that it is postponing documentation requirements indefinately, it appears as though the regulations will undergo major cosmetic surgery, possibly moving the compliance date into 1999. "HCFA has shown they are reasonable and willing to address the AMA’s concerns," Smoak says.

Many information systems, however, are based on regulations established last October. Software developers are watching the issue closely, poised to rewrite code that matches any changes made to the regulations, which will eventually become mandatory for all patient encounters reimbursed by HCFA. Private insurers, too, are expected to adopt identical regulations in the near future, making it virtually ubiquitous.

Don Rucker, a technology consultant for electronic medical records developer Datamedic, Waltham, Mass., and emergency medicine faculty member at Beth Israel Hospital in Boston, is confident that the regulations, regardless of their composition, will force physicians to consider automating more of their processes. "No matter what the specifics are, there will be a push toward IS."

In the past, he says, documenting encounters was simply a matter of complete dictation. Now, dictation alone will not suffice. "This is not necessarily the type of information that comes naturally," he says. "I think the only way people will be able to cope with new regulations is with computer support."

--Jeffrey Elliott


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