A recent New York Times article titled Medicare Bills Rise as Records Turn Electronic has launched a firestorm of response and counter response. The article makes the case that “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.” It continues with:
Some experts blame a substantial share of the higher payments on the increasingly widespread use of electronic health record systems. Some of these programs can automatically generate detailed patient histories, or allow doctors to cut and paste the same examination findings for multiple patients – a practice called cloning – with the click of a button or the swipe of a finger on an iPad, making it appear that the physicians conducted more thorough exams than, perhaps, they did.
Critics say the abuses are widespread. “It’s like doping and bicycling,” said Dr. Donald W. Simborg, who was the chairman of federal panels examining the potential for fraud with electronic systems. “Everybody knows it’s going on.”
The effect of the article is like a boulder being thrown into a fairly calm lake – the initial splash is spectacular and I expect that the ripples will continue to for months if not years to come.
HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder have sent a letter to the American Hospital Association, Association of Academic Health Centers, Association of American Medical Colleges, Federation of American Hospitals and National Association of Public Hospitals and Health Systems, warning that law enforcement
“will take appropriate steps to pursue health care providers who misuse electronic health records to bill for service never provided. The Department of Justice, Department of Health and Human Services, the FBI and other alw enforcement agencies are monitoring these trends, and will take action where warranted.”
The next letter to be publicly released was a direct response to Secretary Sebelius and Mr. Holder from Rich Umbdenstock, the President and CEO of the American Hospital Association. In his letter he agrees that “the alleged practices described in your letter, such as the so-called “closing” of medical records and “upcoding” of the intensity of care, should not be tolerated.” With those niceties out of the way the letter went on to try and make the case that “more accurate documentation and coding does not necessarily equate with fraud.”
He then continues by saying:
“What’s needed is clearer guidance from CMS, not duplicative audits that divert much needed resources from patient care. In recent years, CMS has drastically increased the number of program integrity auditors that review hospital payments to identify improper payments. No one questions the need for auditors to identify billing mistakes; but the flood of new auditing programs, such as Recovery Audit Contractors, MACs and others, is drowning hospitals with a deluge of redundant audits, unmanageable medical record requests and inappropriate payment denials.”
Now others are beginning to chime in as well. HIMSS Executive Vice President Carla Smith, in a post on the HIMSS Blog titled Investigating the Unintended Outcomes of IT Use in Healthcare says that “ it is good and right to have reputable journalists, such as those at the New York Times, asking probing questions about the use of EHRs and other health IT.” Then goes on to say that she “take issue with the introductory paragraphs of the Times’ article, which propose a causal link between the EHR Incentive Program payments and the OIG’s findings.”
Ms. Smith goes on to say “…it would be naïve of us to not realize that there is, as in all sectors of our economy, the potential for fraud and abuse. Hence, I appreciate the spot-light reputable journalists and committed HIMSS members shine when asking probing questions, and digging for the truth.”
In conclusion I’m reminded of a line from my all time favorite movie:
Rick: How can you close me up? On what grounds? Captain Renault: I’m shocked, shocked to find that gambling is going on in here! – Casablanca, 1942.