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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.'"
Mission Accomplished!
“He’s not deformed, he’s just drunk!”
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.
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?
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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.)
Yes, some physicians will abuse the system. Some will do so willingly, while others will do so out of ignorance. However, many physicians at large academic medical centers (also known as "residents"), are not taught how to code and bill at all until they reach independent practice. This leads to very bad habits and often to underbilling quite significantly for their services. They all do the work, but don't appreciate the importance of recording and documenting the work for billing purposes, leaving money on the table. This impacts primary care most of all, where margins are very slim, and many physicians are struggling to remain solvent. EMRs actually take care of the coding and billing far more efficiently and accurately than the physicians themselves. But as the saying goes, "garbage-in, garbage-out." The coding is only as accurate as the physician documentation. The vast majority of physicians do not intentionally document erroneously to inflate billing - once the error is pointed out to them, they are more than willing to fix it. And for those physicians who are maliciously abusing the system, there's no better solution than EMRs to record and track this behavior.
...is how much health care costs in the first place.
In a fee for service environment:
improved efficiency = increased throughput = higher cost
savings only come about when you increase throughput on a flat wage, which lowers your per unit cost.
Unfortunately, healthcare IT (a field in which I work) is one in which the benefits are not immediately realized by the ones who bear the costs. In fact, one could argue that even the benefits (in terms of short term patient harm reduction via medication errors, etc) will really only increase longer term costs when patients live longer and as a result require more care.
There are fundamental, paradigmatic, changes that need to happen in the healthcare system if it is to survive.
PS: I'm Canadian, so that is the context of my comment.
You know, I was reading an article where it stated that socialised medicine would cost *less* than what what it costs to run Medicaid and Medicare (on a per person basis)
You Yanks fear the word "socialist" so much you spend far more to get rid of it!
I am an ACCA student. Got a query on Accountancy/Finance? Maybe I can help!
... that there are always some who will push the legal and ethical envelope in order to make a larger profit. Such is the way of Capitalism, it appears.
universal healthcare will result in longer lives and less healthcare spending in the usa. just like every other goddamn country with it
but, much like gun control, there is a certain feverish moron in my country that will never listen to reason on the subject, and he enabled by special interest groups in washington: the NRA and the healthcare insurers
maybe the feverish morons will shoot themselves and die waiting in the emergency room
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Forgive my AC status, but for obvious reasons I can't divulge too many details. I was a contractor for a state government to facilitate writing an EHR system to integrate various state repositories for the purposes of the grants relevant to this story.
Of course this is going to cost more up front. We had to bring online hundreds of medical facilities who were operating with paper only with processes who's roots go back to the 1950s. The purpose of the grants was to MITIGATE the costs, not cover them completely.
The fact is that in the long run this will save money and is well worth the increase now. That increase would have been larger for every year longer we waited to bring some of these places into the modern era.
Physician here. Medicare/Medicaid is tied to really arcane and often inane rules. You must document X of this and Y of that and word it in a specific way to get paid. What you actually do for the patient does not always matter but the way you document it makes a big difference. EMR has made it easier to conform to the rules and makes sure you write notes that can be easily billed for. It has simplified documenting for things that are tedious to do on paper (like review of systems, and counseling).
Doesn't sound like electronic records is the problem. Fraud seems to be the problem.
Read what I mean, not what I wrote.
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.
The story being a NYT article, I don't think you can cry spin on this one.
Imagine that you are a cardiologist. You work at a large hospital in Oklahoma City. You are about to perform a heart catheterization on a patient. The âoesystem goes down.â What ? You mean that a computer system might fail? You have no medical records because they are digitalized on âoethe system.â You have no idea what this patientâ(TM)s history is or what it is they need or what you had planned to do for them. You ask the patient,â..do you mind telling me what it is that I see you for?â
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Sticking to wealthy countries (source):
Country | % Health spending/GDP | % Public health spending/Total health spending
USA 17.9 53.1
Netherlands 11.9 79.2
France 11.9 77.8
Germany 11.6 77.1
Switzerland 11.5 59.0
Denmark 11.4 85.1
Canada 11.4 70.5
UK 9.6 83.9
Sweden 9.6 81.1
Japan 9.5 82.5
Norway 9.5 83.9
Finland 9.0 75.1
I'm fairly certain that the total U.S. government spending per capita on health care is more than the UK spends per capita for its universal system.
a free market in real life translates to "give as many expensive tests as we can get away with"
healthcare isn't a MARKETPLACE. it is not driven by best price, because the buyer has no control to seek the cheapest service. no knowledge of medicine. no time when he is having a heart attack to shop around
face reality: there are some issues in life, where, believe it or fucking not, market forces do not help, and make things worse
i say this as a committed capitalist. capitalism works. but i'm not a looney tune frothing at the mouth ignorant free market fundamentalist who believes the magic unicorn and rainbows marketplace is a magic elixir that solves all problems. it doesn't
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
The type of fraud described in the article is not restricted by medicare but is pretty much standard practice in most medical offices that use electronic billing.It is a simple play on the "power of the default" that makes it difficult for doctors to behave honestly even if they don't intend to carry out fraud. The way it works is that when a doctor or a nurse pulls a page for a particular task, all possible tests and procedures are checked by default. In many cases there are a dozen or so check boxes that the doctor will have to actively uncheck if he/she needs to just take the pulse of the patient. Naturally, doctors don't have neither the time nor the patience to click around the screen. They also don't have the incentive to reduce their income while wasting their time. An obvious and simple solution would be to set the default to all procedures unchecked and require manual input for to check the boxes. If I remember correctly this is how electronic records are handled in the Keiser hospitals. Another thing that should be required is to retain and provide unique tracking information for every sample and test being done. This is also not difficult because the sample tracking is already part of the software. Finally it should be legislated that the medical records belong to the patient, not the medical office. I don't see why I have to repeat the same panel of tests and fill same questionnaires every time I choose to ask for a second opinion or if due to various reasons I seek help from a different practitioner.
The majority of voting yanks are wankers. Those who do not vote do not matter.
The half that vote has severely limited choices and are misinformed most are probably wankers.
I'm a yank but I'm in the minority; the voting informed who are not wankers.
http://www.youtube.com/watch?v=B5OWRRJh-PI
Democracy Now! - uncensored, anti-establishment news
It's Obama's fault for oversimplification of the problem and with his Democratic cohorts, Pelosi, Reid et al. for doing a lot of backroom deals to push bad legislation through. Do we all want affordable health care? Yes! Do we want to be able to make sure that we can get care for pre-existing conditions? Yes! Do we want 16000 new IRS agents enforcing the insurance mandate? No.
Ask yourself why an industry like the health care industry has seen increases in costs much faster than inflation? Sure, the number of uninsured has risen but also some of these deals that were made allow the drug companies and others to not be challenged in terms of their costs. They will continue to rake in record profits and are allowed monopolies in this country that they shouldn't have. You think software patents are bad? How about the prohibition of importing drugs from say India? You have a licensed monopoly and they will rape you for every dollar.
Electronic Record keeping isn't bad, it's bad when you have fraud already and you don't work on closing that out before you give crooks another way to steal from us all.
Also, despite the "grand legislation" there are more uninsured as of 2011 then there were back in 2008 when they started tracking it.
Almost 18% of GDP is spent on healthcare in this country now and in comparison to other developed nations we spend more than our peers. Germany spends 10% of their GDP on Healthcare with 22% coming from private spending, meaning insurers and the government pay out 78%. In the US, 17.9% of GDP is spent on healthcare with 47% coming from private spending. It's an industry out of control and the whole Obamacare legislation won't fix it.
So, I don't just blame Obama, I blame the Democrats and the Republicans, in fact all of these idiots in DC and the statehouses who have allowed this to happen to us. I'll be retiring in 20 years, probably into a cardboard box. Why? Because I'll get free health care and I won't have to pay any taxes.
Harrison's Postulate - "For every action there is an equal and opposite criticism"
While costs may be going up in the short term, the long term savings in life and treasure by moving to electronic records will more than make up for it.
Just allow billing per hour at a fixed rate, regardless of what the procedure is. Problem solved.
If you reward medical service providers for providing as many services as they can (or in fraud cases billing for services they don't provide), then you should not be surprised to find costs growing out of control.
Ancient Chinese Proverb went something like: "Pay doctor when you are healthy. Stop paying doctor when you are sick." That creates the financial incentives for the medical profession to be efficient.
There are some providers in the USA that break out of the fee for service model and provide good, efficient care.
what's more likely:
a) Rates drop since Insurance Companies couldn't just check up on their competitors rates and use that information to fix prices without colluding (*cough*auto-insurance*cough*).
c) Insurance Companies pocket the savings and pay them out in the form of big cash bonuses for the board of directors?
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The problem is bureaucracy. I work in a clinic, and the new Electronic Health Records REQUIRE every patient's email address. The Health Care regulations require that the patient be able to access his or her records securely online via a website. The problem is that our clinic has a lot of senior citizens and nursing home patients. An 85-year-old usually does not have an email address, in my experience. Thus the clinic is forced to use dummy email addresses etc. The system won't allow a blank, and the government will not reimburse for empty records.
Yours is an on objective and thoughtful comment. I would just like to add some more which I don't think is well recognized.
The individual mandate idea originated with Republicans and conservative think tanks. Hilary Clinton took up the idea, but Candidate Obama did not favor it, and had some sensible and insightful things to say about it (see link). Somehow the idea found its way into the healthcare bill, which then went on to be adopted without a single Republican vote. Yet Republicans who favored their own mandate-including bills earlier criticized the mandate when it was part of a Democrat bill (same link again). Anyone could be forgiven for being completely bewildered and whipsawed on this issue.
Anybody who thinks the facts given on the page linked are mistaken, please make your case. At this point, I don't have any axe to grind on this issue. Some of the people I respected on this issue have revealed themselves over time to be hypocrites, and I am wide open on this subject.
in the economy. It's about making sure basic needs are met, and working towards improving what is 'basic'. If all you need to be a socialist was government intervention then George Bush jr's administration, with it's bank bail outs and two wars, would be the greatest socialist regime in history...
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What do they want? They forced everyone to use EMRs and now that the doctors who have to spend 4 times the amount of time to input everything into EMRs have discovered word macros the government is crying that it isn't fair? Did they really think a bean counter with a spreadsheet at the hospital wouldn't figure out how to optimize billing with the codebook they government created? What's next, you can only bill if you type everything out and laws will be passed banning CTRL-V in hospitals? This isn't just stupid, its fucking stupid.
"The Medicare program is a target for fraud because it is based on the "honor system" of billing. It was originally set-up to help honest doctors who helped the needy with medical services."
...ObamaCare - yet another RESOUNDING SUCCESS of this administration. On every account.
Let's take a system that's rife with fraud, and instead of fixing it, let's make it BIGGER. What could possibly go wrong?
On top of that, let's put out several thousand pages of new regulations, taxes, fees, and surcharges, and let's hire an additional 11,000+ IRS agents to monitor all that. Of COURSE costs will go down!
Those private insurance companies that have fraud rates in the 1%-2% neighborhood, compared to the Medic[are/aid] fraud rates in the ~20%? Let's impose price caps and other financial limitations on them, while forcing them to provide more and more coverage. Profits? Who needs them, when you're talking about "the greater good"? So, they'll go out of business, serves them right, those fat cats. Who cares if they were 10 times more efficient than government-run health insurance?
"In fiscal year 2010, the Centers for Medicare & Medicaid Services (CMS)—the agency that administers Medicare and Medicaid—estimated that these programs ade a total of over $70 billion in improper payments." Source: GAO testimony, March 9, 2011, retrieved from http://www.gao.gov/assets/130/125652.pdf
Challenge accepted!
I've seen this widely stated, including by Politfiact (http://www.politifact.com/truth-o-meter/statements/2010/apr/01/barack-obama/obama-says-heritage-foundation-source-health-excha/), but never understood why people are claiming equivalency. Like Robert Moffit stated, ""the Obama health-care law 'builds' on the Heritage health reform model only in the sense that, say, a double-quarter-pounder with cheese 'builds' on the idea of a garden salad. Both have lettuce and tomato and may be called food, but the similarities end there."
Keep in mind that PPACA was a thousand page bill and not all thousand pages discussed exchanges. Keep in mind also that the Heritage implementation called for statewide exchanges, not nationwide as PPACA implements. It's another massive difference between the two. And frankly, that alone is more than enough for me to label them "not remotely similar" (it'd be like comparing the local transportation department to the Department of Transportation).
If I had to liken a comparison to this misunderstanding, it would be like taking a generic Democrat-favored idea, like "universal healthcare", and spinning it ideologically in your favor, like "universal healthcare for rich people and oil tycoons", and then claiming it's originally a Democrat idea and wondering why they won't vote for it.