Healthcare News & Insights

Hospital using EMRs to maximize Medicare billing?

Are hospitals using electronic medical records (EMR) to bilk Medicare? That depends on who you ask. 

494385415The Departments of Justice and Health and Human Services recently sent hospitals a strongly worded letter warning them against using EMR inappropriately, reported Kaiser Health News.

The letter was in response to reporting by the Center for Public Integrity and the New York Times that found hospitals using EMR systems were billing Medicare for significantly more than hospitals still using paper records. According to the reports, the reason for this disparity is that computers make it easier to charge for more procedures or more expensive procedures than paper records.

Healthy dose of skepticism

“When I read those articles I thought, that’s interesting, I’m not surprised to hear that people are using tools to sort of maximize revenue,” Dr. Ashish Jha, a researcher at the Harvard School of Public Health, told Kaiser Health News.

But his colleague at the University of Michigan, Julia Adler-Milstein, assistant professor of information, and assistant professor of Health Management and Policy, was skeptical. She believed that hospitals already maximized their revenue generation from billing, and that EMR wouldn’t magically make it more lucrative.

So together they designed a study to figure it out.

The study compared billing records from 393 hospitals with EMR systems to 782 hospitals using paper records. The hospitals matched each other in terms of size and status as teaching hospitals or for-profit companies.

“To my surprise, we found nothing,” Dr. Jha told Kaiser Health News. “We found that electronic health records didn’t really change billing practices at all.”

Debate continues

Dr. Donald Simborg started designing computerized patient records in the 1960s, and recently led a pair of government advisory panels on how to guard against fraud in digital health records. This pioneer in the field of EMR disagrees with the study.

His reasoning: It didn’t address a key area — emergency departments and outpatient clinics. This is a concern because according to Dr. Simborg, an increasing number of emergency departments and outpatient clinics are owned or run by hospitals. Adler-Milstein only looked at inpatient records for people who spent at least one night in the hospital.

“Hospitals already have software that helps them [maximize billing for inpatient stays]. They’ve been doing that for years,” Dr. Simborg told Kaiser Health News.

However, emergency room and outpatient clinic docs are just now getting EMR, which he observed sometimes prompted them to over-document.

“I would see that they were documenting things that I know they didn’t do to the patient. And these were not crooks, it’s just kind of human nature about having a tool that’s so easy to click a button that puts in a lot of default information when you’re in a hurry, because physicians are always in a hurry,” Dr. Simborg said.

EMR systems help physicians be more efficient by automatically filling in standard protocols for certain types of visits. But they can also get doctors in trouble if they forget to delete things they didn’t do during a visit, because it can generate a higher-than-necessary bill.

But Dr. Simborg doesn’t believe that threatening hospitals is the way to fix this problem. He believes federal watchdogs should focus more of attention on the software industry.

“They can develop the guidelines that would reduce the likelihood that an electronic record would be abused,” said Dr. Simborg, like making it easier for auditors to follow a doctor’s digital recordkeeping trail. “That’s different than threatening that they’re going to be prosecuted if they do these things.”



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