Recent revelations that the transition from paper-based to electronic health records (EHR)/electronic medical records (EMR) is increasing Medicare costs – possibly by encouraging fraud – is leading some to call for a halt to the whole EHR process, saying it is increasing costs without improving patient care. While the program had been started in the federal government under President George W. Bush, it had been expanded by a February 2009 decision by Congress and the Obama administration to spend as much as $30 billion in stimulus funding. (Ironically, part of the argument in favor of the investment was that it would reduce medical costs.)
It all started in late September, when the Center for Public Integrity published the results of a year-long investigation into the effect of billing and coding practices on Medicare costs, coupled with a front-page article, followed by an editorial, in the New York Times on the research.
“The Center’s probe uncovered a broad range of costly billing errors and abuses that have plagued Medicare for years—from confusion over how to pick proper payment codes to outright overcharges,” wrote CPI. “The findings indicated that Medicare billing problems are worsening as doctors and hospitals switch to electronic health records.” Costs could add up to $11 billion, the organization said.
The first shoe to drop was that U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder notified five medical groups of their intention to ramp up investigative oversight, including possible criminal prosecutions, CPI wrote. “There are troubling indications that some providers are using this technology to game the system, possibly to obtain payments to which they are not entitled,” said Sibelius in a letter to the five groups. “There are also reports that some hospitals may be using electronic health records to facilitate ‘upcoding’ of the intensity of care or severity of patients’ condition as a means to profit with no commensurate improvements in the quality of care.”
In response to Sibelius’ letter, four Republican House leaders sent their own letter to Sibelius, asking federal officials to suspend payments to hospitals and doctors who switch from paper to electronic health records. The letter was signed by Ways and Means chairman Dave Camp, R-Mich., Energy and Commerce Chairman Fred Upton, D-Mich., Ways and Means health subcommittee chairman Joe Pitts, R-Pa. and energy health subcommittee chair Wally Herger, R-Calif. The presenting issue was on implementation of the next stage of the program, which they said offered fewer assurances for record interoperability than the previous stage.
Other groups chimed in, with some saying the federal government should not be involved in providing incentives for the program at all, while other articles reported a backlash against EHR systems in general.
However, the head of the Office of the National Coordinator for Health Information Technology for IT programs indicated he felt that the Republican letter was prompted by partisan concerns. “With HHS unlikely to stop issuing incentive checks and this being an election year, this most recent criticism of the EHR Incentive Programs is little more than political posturing,” noted Kyle Murphy in EHR Intelligence.
Moreover, reports from the Bipartisan Policy Center indicated that the lack of interoperability was not a serious problem, while other studies showed that EHR did, too, improve patient health, particularly in the case of diabetes.
That said, several EHR issues are thought to be increasing costs, CPI and others have found, including:
- new, more specific billing codes
- the ability to cut-and-paste documentation that helps justify the higher billing (which has the additional side effect of perpetrating incorrect information, a study found)
- lack of fraud-detection software
- the desire to recoup the cost of the EHR software, plus a certain degree of “payback” for work that might have been done previously and not reimbursed accurately
- hospitals publicizing per-doctor revenue reports to implicitly encourage other doctors to step up
Aside from the money the hospitals and medical groups might be making is also the amount of money the EHR vendors can be making, with the the EHR Systems market in North America expected to grow at a CAGR of 7.85 percent over the period 2011-2015 – primarily because of the increase in government support, according to a recent report by TechNavio.