title: The impact of changes in HCFA documentation requirements on academic emergency medicine: results of a physician survey.
abstract: BACKGROUND
  The Health Care Financing Administration (HCFA) has dramatically increased documentation and procedural supervision required by faculty in academic emergency departments (EDs).
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: McLean
authors.forename: J A
authors.initials: JA
authors.lastname: Feldman
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000328:Adult; D001291:Attitude of Health Personnel; D014487:Centers for Medicare and Medicaid Services, U.S.; D002648:Child; D004282:Documentation; D004635:Emergency Medicine; D006801:Humans; D007588:Job Satisfaction; D009511:New England; D011795:Surveys and Questionnaires; D014481:United States