EMRs: The Law of Unintended Consequences

The government has been pushing for electronic medical record keeping for many years.  The thought was it would drive efficiencies, reduce costs and improve care.  Billions in incentives have been spent trying to get hospitals and providers to upgrade their systems to allow for electronic medical record keeping.

This New York Times article shows that Medicare is finding much higher billing increases from the providers with electronic medical records than those without it.  The main reason is the new systems allow for easy "upcoding" of services.

Some examples include: the emergency department Faxton St. Luke's Healthcare in Utica, NY with a 43 percent increase in patients "needing" the highest levels of treatment the first year the hospital began using electronic health records. Baptist Hospital in Nashville, TN saw an 82 percent increase in the highest-paying claims the year after the hospital started using a software system for emergency room records.

In a whistle-blower lawsuit filed in 2007, Dr. Alan Gravett, a former emergency room physician, contended that these techniques drove Medicare reimbursement levels substantially. When Methodist Medical Center of Illinois in Peoria rolled out an electronic records system in 2006, Gravett, said the new system prompted doctors to click a box that indicated a thorough review of patients’ symptoms had taken place, even though the exams were rarely performed. Another function let doctors pull exam findings “from thin air” and include them in patients’ records.  When it's electronic, cut and paste with "pre-filled text" is easy. Methodist’s Medicare billings for the highest level of emergency care jumped from 50 percent of its emergency room Medicare claims in 2006 to more than 80 percent in 2010, making the 353-bed hospital one of the country’s most frequent users of high-paying evaluation codes. We all intuitively know the 50 percent is likely inflated, and the 80 percent is just not possible.

Many 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.

The New York Times article cites many examples, facts, statistics and studies showing how this catastrophic issue is becoming even more prevalent.  Rising must stay on the look-out for this trend of cloned medical records and patients must start being on the alert for overbilling. One patient in the article took action on an instance of overbilling.  The patient was seen in the emergency room of a Virginia hospital for a kidney stone. When he received the bill from the emergency room doctor, his medical record -- produced electronically -- reflected a complete physical exam that never happened, allowing the visit to be billed at the highest level.  Ultimately, the only thing that can stop this abuse is more consumer involvement.