Primary Care Physician Perceptions of the Impact of CMS E/M Coding Changes and Associations with Changes in EHR Time.

Abstract

Background: In 2021, CMS changed ambulatory evaluation and management (E/M) documentation requirements to reduce physician documentation burden. No prior work has assessed primary care physician (PCP) perceptions of the impact of these changes.

Objective: To determine whether physicians both perceived and objectively experienced a reduction in documentation time.

Design: We used cross-sectional and longitudinal survey data of PCPs and linked it to electronic health record (EHR) data. The setting was a large academic medical center (UCSF Health).

Participants: Eighty-seven PCPs.

Main measures: Physicians completed pre- and post-surveys about whether the CMS changes affected the amount of time and effort they spent on documentation. We compared survey data to objective audit log measures of documentation time per E/M encounter.

Key results: PCPs perceived spending less time and effort on documentation of Review of Systems (84% reported a moderate or significant decrease) and History of Present Illness and Physical Exam (41%) after the E/M coding change. Further, we found a shift towards PCPs perceiving that they spend more time on clinically meaningful documentation. We did not find a significant association between perceived and actual changes in documentation time (b= -0.01, s.e.=0.019, p=0.666 for History of Present Illness and Physical Exam; b= -0.01, s.e.=0.021, p=0.780 for Review of Systems). Limitations of the study included using data from a single site and a relatively small sample of PCPs.

Conclusions: PCPs perceived spending less time and effort on documentation after implementation of the 2021 CMS E/M coding changes, changes intended to reduce documentation burden. Using physician perception as an indicator can potentially contribute to understanding the impact of federal policies aimed at reducing documentation burden.