Revised CMS Rule Should Ease Preceptors’ Administrative Burden, Help with Recruitment

Note: An update to this article was published on Wednesday, May 9, 2018.

A change in the Centers for Medicare and Medicaid Services (CMS) rules that govern student-written notes in medical records should make life easier for preceptors — and give clinical coordinators one more tool for recruiting them. The change was driven by advocacy from the Society of Teachers of Family Medicine (STFM), supported by PAEA, which is represented by both staff and members on the oversight committee and tactic teams related to STFM’s Preceptor Expansion Initiative. PAEA recently contributed $75,000 to the initiative, a major interprofessional effort to expand access to community clinical sites and preceptors.

An update to the CMS manual released late last week “allows the teaching physician to verify in the medical record any student documentation of components of E/M services, rather than redocumenting the work.” The term “teaching physician” has not changed in this revision and has always been interpreted as referring to PA and NP preceptors as well. The rule also clearly refers to PA students.

Freeing Up Preceptors’ Time

This change should provide significant administrative relief for preceptors who previously had to rewrite student notes in a patient’s record. According to an STFM survey of preceptors of both medical and PA students, more than 90 percent of respondents said that allowing students to help more with documentation would save them administrative time after clinic. And a large majority of respondents strongly agreed that allowing the student note to be used as documentation for billing purposes would allow them to spend more time teaching, consider precepting additional students, and enjoy the practice of medicine more.

“This rule change is a big win for PA programs and our efforts to improve the clinical education environment for PA students,” said PAEA President Lisa Mustone Alexander, EdD, MPH, PA-C. “We’ve had a long and productive relationship with STFM over the years, and I think this positive rule revision by CMS shows the power of organizations working together to make the case for change.”

Improving Students’ Skills

The rule change will also help give students more opportunities to develop their medical documentation skills, said Nick Hudak, MPA, MSEd, PA-C, a clinical coordinator at the Duke University PA program and a former chair of PAEA’s Clinical Education Committee. “Medical documentation is a major responsibility of clinicians, but prior CMS regulations deterred many preceptors’ efforts to have students practice documentation because student notes had minimal utility in the permanent health record. We’re very hopeful this rule revision will increase PA students’ ability to practice medical documentation skills and allow preceptors more time to provide feedback and facilitate student learning.”

PAEA has strengthened its relationship with STFM in recent years as the Association has doubled down on building networks in its ongoing effort to help relieve shortages of preceptors and clinical sites. Two senior PAEA staff members, Olivia Ziegler and Dave Keahey, sit on the STFM Preceptor Expansion Oversight Committee, along with AAPA staff member Michael Powe, who was instrumental in securing the change in CMS regulations.

We encourage all programs to convey this information to students and preceptors. Stay tuned for more news as PAEA works to develop tools based on this and other successes in improving the environment for PA clinical education.