The impact of changes in HCFA documentation requirements on academic emergency medicine: Results of a physician survey

Background: The Health Care Financing Administration (HCFA) has dramatically increased documentation and procedural supervision required by faculty in academic emergency departments (EDs). Objectives: To determine academic emergency medicine (EM) physicians' perceptions of the impact of HCFA documentation requirements (HDR) on teaching time, clinical efficiency, and job satisfaction. Methods: An observational cross-sectional study was done using a survey of New England academic EM faculty from September to December 1999. E-mail surveys were followed by hard copy to nonresponders. Teaching time, clinical efficiency, and job satisfaction were rated on a five-point Likert scale. Yes/no questions about other possible benefits of HCFA regulations were asked. Frequency (95% CI) and chi-square analyses were performed. Results: One hundred seventy-four of 233 (75%) responded. Eighty-nine percent (95% CI = 84% to 93%) of, the respondents thought teaching time was somewhat or markedly decreased by changes in HDR (somewhat 46%, markedly 43%). Seventy-nine percent (95% CI = 73% to 85%) believed clinical efficiency was somewhat or markedly decreased by changes in HDR (somewhat 49%, markedly 30%). Eighty percent (95% CI = 73% to 86%) reported somewhat or markedly decreased job satisfaction due to changes in HDR (somewhat 56%, markedly 24%). Twenty-one percent (95% CI = 15% to 27%) believed changes in HDR had improved patient care by requiring increased patient supervision. Forty-eight percent (95% CI = 40% to 56%) thought that changes in documentation requirements had decreased medicolegal risk by improving patient documentation. Conclusions: Most academic EM physicians in New England perceive that HDR have decreased clinical efficiency, teaching time, and job satisfaction, These findings suggest that changes in HDR may have a substantial impact on many different aspects of emergency care provided in academic settings.