Wednesday, November 14, 2012

Using the F-word when it comes to EHRs


As EHRs gain ground I suspected that all would not be as HHS had hoped. HHS fueld the fire incentivizing and penalizing providers according to the time period in which they adopted EHRs.

I suspected that standardized and automated coding that would operate by totalling the procedures and diagnostic evaluation and management codes that were previously neglected or forgotten by providers engaged in a patient visit.


Richard Patterson MD seconds my motion in his post on KevinMD (blog). His post is in response to the HHS suspecting there is a lot of “F” going on in billing and coding. Not so says Dr Patterson, and I agree. Most providers already know this as they have seen their income increase due to proper coding and billing as compared to pre electronic paper and pencil coding.

Previously providers would use a 'superbill' and manually check off diagnoses and CPT codes for billing. Charges were frequently missed. Thanks to HHS edicts they are now getting what they asked for and what they deserve. Their activites never save money. That would be a 'never event' Ironically they invested about 45,000 per MD to 'incentivize EHR and are now paying the price of more efficient billing. It is hard for this writer to avoid sarcasm, and it does not take a multi-million dollar study to analyze what has happened.

Now the doctor, without sacrificing time-efficiency, can incorporate fully informative entries into the chart that will satisfy the criteria by which the coders are bound, and the result will be a universal billing form that more accurately describes what was wrong with the patient and what the institution and doctor did for him or her.

Of course HHS assumes that 'F” is involved...Dr Patterson goes into some length in unravelling this supposed gordion knot which my 8th grader could figure out. This is what happens when bureaucrats who have no clinical or patient experience make rules, set edicts and in general go where they don't belong. This is what happens when an ex-governor with no prior medical involvement is appointed Head of HHS.

My mantra is 'keep the politicos out of my health care.' Most Americans will espouse that, however are willing to let them write the checks for their health bills.

Patterson aptly sums it up:

The Secretary and AG allege that providers are “cloning” EHRs, somehow documenting services that were not actually provided. If so, that deserves the “f-word” and all the legal consequences that go with it. I think any such behavior represents a vanishingly small fraction of the increase in charges they have observed, though. I think they are seeing the consequences of ARRA EHR mandate, and I believe they will see more and more as EHRs become more widely utilized.

This is a completely predictable outcome. One of the attributes touted for EHRs is the standardization and completeness of the medical record, creating one that can be shared by multiple users and be meaningful for all.

I am confident that HHS/Medicare and the insurance companies will find ways to neutralize the resulting increases in charges.

Stand by for another SGR fiasco.

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