Medicare Bills Rise As Records Turn Electronic

theodp writes "As part of the economic stimulus program, the Obama administration put into effect a Bush-era incentive program that provides tens of billions of dollars for physicians and hospitals that make the switch to electronic records, using systems like Athenahealth [note: video advertisement] (which made U.S. CTO Todd Park a wealthy man). The goal was not only to improve efficiency and patient safety, but also to reduce health care costs. But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care. Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to a NY Times analysis. There are also fears that features which can be used to automatically generate detailed patient histories and clone examination findings for multiple patients make it too easy to give the appearance that more thorough exams were conducted than perhaps were. Critics say the abuses are widespread. 'It's like doping and bicycling,' said Dr. Donald W. Simborg. 'Everybody knows it's going on.'"

Comments

Medicare fraud is not new

[bit trollent]

Medicare fraud is not new. It existed way before electronic records.

Florida's governor, Rick Scott's company committed medicare fraud way before electronic records were introduced.

Electronic records should make it easier to detect medicare fraud, as statistical analysis is much easier with computerized systems.

This is silly

[rsilvergun]

it's already been established that moving to electronic records helps track Medicare fraud. Yes, the system has a lot of gaps, but electronic tracking reduces them. If that wasn't true companies wouldn't use electronic purchasing systems to track expenditures, and the spreadsheet would just be an interesting foot note in computer history...

I gotta ask (since I'm far too lazy to read the article): Is this a lame attack on the existing administration?

Proper coding != fraud

[Anonymous Coward]

It's not clear to me that medicare providers changing their coding is the same as fraud. If a doctor was coding for a 10 minute E&M (evaluation and management) but was actually spending 20 minutes with the patient, then it's totally reasonable for them to change their coding. If EMRs are making it more obvious that the practice users are mis-coding, then this is at worst an unintended side-effect of the EMRs.

(Full disclosure, I work for a company that builds EMR systems.)

Re:Proper coding != fraud

[salesgeek]

Now, the Australian company you declined to work for, they seem like the kinds of scum who hospital administrators might hire to commit wholesale fraud. That obviously would give rise to increased billing rates. If there's still a sliver of justice in the world, they'll go to jail for falsifying records.

Both the company providing the service and people enriched by using that service need to be held accountable.

So the fraud is now exposed...

[Slyswede]

My impression is that the US health care system has been doing this for as long as it has existed. Having digital records should be a great help to the insurance companies to make it easier to track down fraudulent health care providers.

Since I live in Sweden I don't usually have a problem with health care bills, but once during a vacation to the US I had to visit a hospital due to severe stomach pain. Four hours and a trip through the CT machine later I was released with a prescription for some pills. Six months later (back home in Sweden) a bill for $14000 arrives...

When I brought this to my insurance company and explained that the examination I went through couldn't possibly have cost that much they just shrugged and said "yeah, they always try this when dealing with foreign insurance companies". A few weeks later they had everything settled at just under $3000.

So what's the point of this story? If a system is open to exploitation you need someone to monitor it. Monitoring is easier with good records of what's been going on.