title: Clerkship directors' perceptions of the impact of HCFA documentation guidelines.
abstract: OBJECTIVE
  Chart notes are used to support billing codes under the evaluation and management guidelines of the Health Care Financing Administration (HCFA), in addition to serving as a record of the visit. To better understand the effect of the HCFA documentation guidelines, the authors collected data on how the guidelines affect participation by university- and community-based faculty in clinical education programs.
  
  
  METHODS
  In 2000, the authors sent six copies of their questionnaire to the associate deans of the 125 U.S. medical schools and requested they distribute them to all core clerkship directors. The questionnaire consisted of multiple-choice and short-answer questions regarding documentation of medical visits, participation of community-based faculty, understanding of HCFA documentation guidelines, and effects on education programs.
  
  
  RESULTS
  The response rate was about 50%. Most of the 379 clerkship directors who responded (77%) stated they were aware the HCFA documentation guidelines include specifications regarding the role medical students can play and documentation of medical visits, and 64% indicated they were concerned the guidelines would affect their educational programs. Concerns included the loss of student independence and active participation in the patient care environment (37), time constraints and the changing balance between education and service (16), loss of faculty and decreased morale (11), and decreased quality of care for patients (7).
  
  
  CONCLUSIONS
  Leaders of medical education must work to modify these guidelines to protect the quality of patients' care, while maximizing students' educational opportunity and participation.
authors.affiliation: Family Medicine, Oregon Health and Science University School of Medicine, Portland 97219, USA. safields@ohsu.edu
authors.forename: Scott A
authors.initials: SA
authors.lastname: Fields
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Morrison
authors.forename: Ernie
authors.initials: E
authors.lastname: Yoder
authors.forename: Kevin
authors.initials: K
authors.lastname: Krane
authors.forename: Thomas
authors.initials: T
authors.lastname: Agresta
authors.forename: Rich
authors.initials: R
authors.lastname: Esham
authors.forename: Frederick
authors.initials: F
authors.lastname: McCurdy
authors.forename: Jonathan
authors.initials: J
authors.lastname: Rosen
authors.forename: James
authors.initials: J
authors.lastname: Shumway
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D002982:Clinical Clerkship / Q000458:organization & administration*; D004282:Documentation / Q000592:standards*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D009013:Morale; D008486:Physician Executives / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics; D013337:Students, Medical / Q000523:psychology; D013663:Teaching / Q000379:methods; D014481:United States