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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.
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!
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.
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.