Gov't Relations

2020 CMS Proposed Rule Suggests Relief from Documentation Requirements

By Dave Keahey, MSPH, PA-CAugust 7, 2019

Image: Shutterstock

The long-anticipated Centers for Medicare and Medicaid Services (CMS) Physician Fee Schedule Proposed Rule is out.

The proposed rule, released on July 29, includes a rationale, clarification, and liberalization of rules governing all preceptors’ use of PA student documentation. The proposed rule also suggests relaxing documentation capability for advanced practice registered nursing (APRN) students. It notes that PAs and APRNs are “seeking … relief from burdensome E/M documentation requirements that would allow them to review and verify medical record notes made by their students, rather than having to re-document the information.” CMS goes on to state:

“After considering the concerns expressed by these stakeholders, we believe it would be appropriate to provide broad flexibility to …  physicians, PAs and APRNs … to allow [them] to review and verify, rather than re-document, information included in the medical record by physicians, residents, nurses, students, or other members of the medical team. Because this proposal is intended to apply broadly, we propose to amend regulations for teaching physicians, physicians, PAs, and APRNs to add this new flexibility for medical record documentation requirements for professional services furnished by physicians, PAs, and APRNs in all settings.”

This is welcome news for PA education and levels the field for all health professions students in clinical training.

The effort to change the onerous re-documentation requirement began in 2017 when an interprofessional group, the Preceptor Expansion Initiative (PEI), was organized by the Society of Teachers of Family Medicine to approach CMS with a proposal to eliminate preceptor re-documentation requirements for all PA, APRN, and medical students. In early 2018, two transmittals were issued that seemed to eliminate this burden for all students and preceptors. However, subsequent communications with CMS indicated that they intended to restrict this improvement only to medical students and physician preceptors.

The PEI mobilized around this inequity and held multiple meetings with CMS officials and supplied them with documents and a rationale as to why their interpretation was not in the best interests of creating a balanced and well-trained workforce. The PEI also reached out to national stakeholders who were adversely affected by CMS’ limitation on PA and APRN student documentation and who provided us with evidence of harm to the clinical training environment in their systems. Last summer, PAEA organized a campaign for the 2019 Physician Fee Schedule proposed rule that resulted in over 600 comments addressing the issue.

It is important to note that the proposed rule will go through a public comment period ending on September 27, and CMS will take responses into consideration before issuing the final rule in November for implementation in January 2020. In the meantime,PA programs should communicate to preceptors that the more restrictive interpretation about PA and APRN student documentation remains in place for now. The requirement for physical presence of the preceptor for all students remains unchanged.

PAEA will provide members with resources to aid in communication with preceptors about this critical issue. We also will soon be organizing a comment effort to support the relaxation of student documentation restrictions — so stay tuned.

Dave Keahey, MSPH, PA-C

Dave spent 30 years precepting students and serving on the faculty of the University of Utah PA Program. After finishing up a year-long stint in Washington, DC, as a Robert Wood Johnson Foundation fellow, he joined the PAEA staff as chief policy & research officer.