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Teaching Physicians to Get a Break on a Burdensome Task

New CMS rule eliminates need to re-do medical students' input to health records

Feb. 23, 2018 (ACP) -- Thanks to a push by the American College of Physicians and other groups, teaching physicians are going to get a break from one of their most tedious tasks: serving as a kind of stenographer.

The Centers for Medicare and Medicaid Services has decided that teaching physicians will no longer need to retype large chunks of the documentation on patient visits that's been added to health records by non-resident medical students. Instead, physicians will be able to refer to student notes as part of their own documentation.

"This will hopefully make a big difference to teaching physicians," said Dr. Philip Masters, ACP's vice president for membership and international programs. "It will relieve them of the burden of repetitive documentation, remove a disincentive to work with medical students and markedly improve the education experience."

As Masters explained it, CMS has long refused to accept, for billing purposes, patient documentation that was created by medical students who are not yet physicians, with a few exceptions.

"A student could spend an hour and a half with a patient and write a three-page note," he said. "For me to get compensated for this encounter, I'd have to completely redo most of he documentation myself." A general internist by training, Masters formerly worked with medical students as a clerkship director at Penn State College of Medicine.

In addition to creating unnecessary work, because of the documentation rules, "the student's input into the health record has not been valued," he said. In some cases, hospitals and institutions went so far as to not allow students to document at all in the electronic health record, he said.

ACP has argued for electronic health records to play a larger role in medical education. As the College and other internist organizations noted in a 2016 letter to the Association of American Medical Colleges and the Commission on Osteopathic College Accreditation: "As the transition from physical patient records to the EHR has occurred, access to the clinical chart by medical students has become highly variable, as has the opportunity for student learning in the use of the EHR as an important clinical skill in preparation for graduate medical training. In many if not most educational settings for students, current policies restrict access of students to the EHR, and this equates to their being poorly prepared for the practice setting they encounter on graduation."

Now, however, starting March 3, students will be able to document services in medical records that can be used as part of teaching physicians' documentation without requiring them to re-document their work.

Teaching physicians will still need to verify all student documentation and findings, "including history, physical exam and/or medical decision making," according to the new rule. It adds that the physician "must personally perform (or re-perform) the physical exam and medical decision making activities of the E/M [evaluation and management] service being billed, but may verify any student documentation of them in the medical record, rather than re-documenting this work."

Masters described the successful push for a change in policy as an example of ACP advocacy at work.

"Getting CMS to revise a physician procedure issue based on feedback is a major accomplishment," he said. "It's an example of how you can get things changed when you pull together."

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