Effects of the revised HCFA evaluation and management guidelines on inpatient teaching.
OBJECTIVE
In 1996, the Health Care Financing Administration (HCFA) introduced new evaluation and management (E&M) guidelines mandating more intensive supervision and documentation by attending physicians. We assessed the effects of the guidelines on inpatient teaching.


METHODS
Pretest-posttest, nonequivalent control group design.


METHODS
A university hospital and an affiliated county hospital where the guidelines were implemented and an affiliated VA medical center where they were not.


METHODS
Sixty-one full-time faculty who had attended on the general medical wards for at least 1 month for 2 of 3 consecutive years prior to July 1996 and for at least 1 month during the 18 following months.


RESULTS
We evaluated standardized, confidential evaluations of attending physicians that are routinely completed by residents and students after clinical rotations at all three sites. Comparing 863 evaluations completed before July 1, 1996 and 497 completed after that date, there were no significant differences at any of the hospitals on any items assessed. There were also no differences between the university and county hospitals as compared with the VA. Eighty-seven percent of 39 university and county attending physicians returned a survey about their perceptions of inpatient teaching activities before and after July 1, 1996. They reported highly significant increases in time devoted to attending responsibilities but diminished time spent on teaching activities.


CONCLUSIONS
Physicians reported a dramatic increase in overall time spent attending but a decrease in time spent teaching following implementation of the revised E&M guidelines. Yet, evaluations of their teaching effectiveness did not change.
University of Washington, VA Puget Sound Health Care System, Seattle 98108, USA.
S D
SD
Fihn
A M
AM
Schleyer
H
H
Kelly-Hedrick
D B
DB
Martin
D000328:Adult; D014487:Centers for Medicare and Medicaid Services, U.S.; D004282:Documentation / Q000592:standards*; D005260:Female; D017408:Guidelines as Topic; D006766:Hospitals, County / Q000592:standards / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009934:Organization and Administration; D015397:Program Evaluation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013663:Teaching / Q000379:methods / Q000592:standards*; D013997:Time Factors; D014481:United States; D014861:Washington