HealthDay News — There has been no meaningful reduction in electronic health record (EHR) documentation burden in association with implementation of new guidelines for outpatient evaluation and management (E/M) billing, according to a study published online Feb. 22 in the Annals of Internal Medicine.

Nate C. Apathy, Ph.D., from the University of Pennsylvania in Philadelphia, and colleagues analyzed outpatient E/M visits, documentation length, and time spent in the EHR before and after the 2021 American Medical Association guidance change for frequently used billing codes. Weekly provider-level E/M code and EHR use metadata were extracted from September 2020 through April 2021 for U.S.-based ambulatory practices using the Epic Systems EHR.

The researchers found that following implementation of the new guidelines, there was a 2.41 percentage point decrease in level 3 visits to 38.5 percent of all E/M visits (5.9 percent relative decrease from fall 2020). There was a 0.89 percentage point increase in level 4 visits to 40.9 percent of E/M visits and a 1.85 percentage point increase in level 5 visits to 10.1 percent of E/M visits (relative increases of 2.2 and 22.6 percent, respectively). Variation in these changes was noted by specialty. No meaningful changes were seen in measures of note length or time spent in the EHR.


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“Continued monitoring and additional policy action such as enhanced vendor certification requirements and/or incorporating EHR usability expectations as a part of value-based payment redesign will likely be needed to meaningfully reduce burden,” the authors write.

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