Interesting expose In the NY Times of all places.
Punch line:
When the federal government began providing billions of dollars in incentives to push hospitals and physicians to use electronic medical and billing records, 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.
How can this be?
Simple, Watson.
First, a system can provide docs with a checklist of separately billable procedures that they might perform … ensuring a complete check-up and making sure that no billing stone is left unturned.
Second, an e-system can make it easier for doctors to “upcode” a procedure in a way to maximize reimbursement rates.
For example, when a doctor enters a billing code, the system can present him with alternative codes for very similar procedures that get higher reimbursement payments … and tell the doctor what addition work needs to be done to qualify for the higher paying code.
So, maybe just asking the patient a couple of more specific questions may upgrade an examination from ‘simple’ to ‘ complex. The doc can then ask the questions (or not) and check the higher paying box.
Third, an e-system makes it easy for docs to “clone” common ‘boiierplate’ findings from one patients chart to another patient’s chart … saving time and, perhaps, implying a more detailed examination.
The Times says:
As software vendors race to sell their systems to physician groups and hospitals, many are straightforward in extolling the benefits of those systems in helping doctors increase their revenue.
In an online demonstration, one vendor promises that it “plays the level-of-service game on your behalf and beats them at their own game using their own rules.”
An expert says “What’s happening is just the problem we feared” … unintended consequences.
For the record, I think that cutting healthcare costs by reducing doctors’ pay is nuts … there is lots of waste, fraud and unnecessary expense in a grossly inefficient system.
The Homa Files 