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

BackgroundIn 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.ObjectiveTo determine whether physicians both perceived and objectively experienced a reduction in documentation time.DesignWe 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).ParticipantsEighty-seven PCPs.Main MeasuresPhysicians 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 ResultsPCPs 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.ConclusionsPCPs 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.