New 2020 HIT regulations: is the patient's story heard?

February 3, 2020

CMS rules to simplify E/M coding and reemphasize patient narrative.

2020 promises to be an important year as many significant new healthcare industry regulations begin to take effect. 

In his recent blog, NextGen Healthcare’s Government Affairs Advisor Chris Emper highlighted some of the key regulations which will impact delivery systems and the Health Information Technology (HIT) industry alike. Among the new regulations are the Interoperability and Patient Data Access Rules which will ensure patients and healthcare systems have access to insurance claims data, and the Health Data Blocking Rules which are intended to combat any efforts to block the sharing of patient data and the Price Transparency Mandates which require hospitals and health systems to post publicly their prices for specific services. 

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Among the 2020 Centers for Medicare and Medicaid Services (CMS) new rules, there is one that I believe will begin to bring the patient story back into the note documenting the medical encounter. This rule goes by the inauspicious name of the Office Visit Documentation and Payment System Overhaul. It brings about several changes to the coding, documentation and payment system for outpatient office visits, a system that has been in place since the 1990s. 

The system is best known as the Evaluation and Management system (E/M). In essence, the E/M codes govern how a patient encounter must be documented in order to justify a level of service which in turn, determines the level of reimbursement for any given patient visit. Compliance with these documentation rules is very strictly enforced and as a result, over the years, the notes documenting clinical encounters contained less of the patient story or narrative and more data intended to support the billing requirements for a given visit. In essence, the note became an administrative tool much less than a clinical tool. 

The new proposed CMS rules have begun to simplify the structure of the E/M codes. There will be fewer billing levels and physicians will be able to determine the level of reimbursement for a visit based on the time spent with the patient and the clinical complexity of the problems dealt with in that visit. I am hopeful that this will give physicians more freedom to return the clinical encounter note to its intended original purpose-as a tool to capture the patient’s narrative, describe the physical finding and document the physician’s thought process, assessment of the patient problems and the proposed plan for care.  

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2020 is a transition year for this particular rule, and the regulations will be fully implemented in 2021. Some providers have expressed concern that the proposed changes will result in lower reimbursement rates, even though CMS’ declared focus has been on reducing the administrative burden for physicians providing patient care. 

What is clear at this early stage is that these changes are a move in the right direction, and that 2020-2021 will be the years where we begin to see the patient voice returning to clinical documents. I for one, can’t wait.

Dr. Betty Rabinowitz is Chief Medical Officer at NextGen Healthcare, a leading provider of ambulatory-focused technology solutions. Dr. Rabinowitz brings more than 25 years of extensive clinical experience and expansive knowledge of population health and value-based practice transformation.