Don Rucker: Evaluation and Management codes not working in EHR era

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Reducing the burden of Evaluation and Management codes on clinicians is long overdue, according to National Coordinator for Health IT Don Rucker, MD, who fully supports a proposed rule by the Centers for Medicare and Medicaid Services to streamline documentation requirements for providers.

“In an era of electronic medical records, we’ve heard from everybody this is just not working,” Rucker said on Wednesday during a webcast hosted by CMS to discuss the proposed rule for the Calendar Year 2019 Medicare Physician Fee Schedule.

Also See: CMS proposed rule reduces Evaluation and Management coding burden

Rucker made the case that E&M codes have led to “a lot of note bloat” in EHRs—driven by electronic templates designed to capture information—and that the documentation required for Medicare payment is a time-consuming process for clinicians that distracts them from patient care. He also noted that the coding “generates safety issues for patients because the real clinical data is often hidden in all of the billing boilerplate.”

Ultimately, Rucker contends that the proposed CMS rule would have a “profound” impact resulting in a significantly less documentation burden for clinicians treating Medicare beneficiaries.

“This effort, if finalized, will help shift the nation’s electronic documentation away from overly long, form-driven, hard-to-read documents written primarily to satisfy billing requirements to what it was originally intended for—providing high-quality care to patients,” Rucker wrote in an ONC blog.

During Wednesday’s panel discussion on the proposed rule, ONC Chief Medical Officer Tom Mason, MD, commented that reducing the burden of E&M codes on physicians would have a positive effect on EHR usability. Mason noted that in a recent listening session, the American College of Physicians cited documentation burdens as the “No. 1 usability challenge with electronic health records.”

According to Mason, the CMS proposal—if finalized—would improve the effectiveness and efficiency of EHRs, as well as lead to better data analytics and an increased focus on patient engagement.

For its part, the College of Healthcare Information Management Executives issued a statement supporting the CMS proposed Medicare Physician Fee Schedule rule.

“CMS is certainly heeding calls from the provider community to reduce administrative burdens,” said CHIME Public Policy Steering Committee Chair Liz Johnson. “We support efforts to reduce these burdens on clinicians, whether they were created by paper or electronic processes, and to give physicians more time to care for patients.”

“Efforts to reduce regulatory burden and simplify documentation will be welcomed by many as they have long been a challenge,” said Karen DeSalvo, MD, former National Coordinator for Health IT, in a written statement. “This proposal by the Administration has some positive concepts that may help return the focus of the visit to the doctor-patient interaction in the clinical setting.”

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