Aaron Berdofe, MHI – Health Informatics

At this point I think I may revert back to the old-fashioned term of Electronic MEDICAL Records because suddenly they’ve gone from saviors of the healthcare industry to tools of the money-grubbing doctors…at least according to some.  That and we’ve realized that they help the medical community more than they improve the health of people.

Much ado has been made after the New York Times pointed out the obvious fact that physicians were starting to code at higher levels and bill insurers and patients more after they implemented their EMR and perhaps meaningfully using it.   Apparently, the government didn’t foresee that systems designed to document all clinical procedures and bill for them in an efficient manner would in fact increase the number of items being billed.  However, if they would have looked at the word cloud I created from their first Meaningful Use proposed rule (as many others did) they would have noticed that the top topics discussed were in fact EHR, MEDICARE, INCENTIVE, and PAYMENT, linking them all together.  Giving an incentive to use a tool that makes the payment process more efficient will indeed the number of bills for those payments.

If used “Meaningfully”, EMRs produce an abundance of documentation that is annoying to sift through and more annoying to input during a busy day in the office.  But, even though a physician may need to see fewer patients to accommodate their new workflow, each visit can be coded at a higher level because they have tons of documentation to finally support it!  I can understand concern about billing for procedures that weren’t done; that’s either human error or fraudulence depending on the motivation, but that’s always been an issue, EMR or not.  This issue of “Upcoding” though, where the accusation is that physician’s are billing at a higher level when it isn’t justified is a bit silly.  EMRs have only made more transparent the problems that already exist in how medical care is billed.

When documenting a visit through an EMR template, buttons, boxes, and bullets are all checked, clicked, typed in, and sworn at.  A lot of EMRs then go through and calculate what level of visit to code at based on all this clicking.  It just so happens that because more is being documented, higher levels are being calculated.  There are plenty of physicians out there that are still too afraid to go with the system’s recommendation though and they end up going down a level.  So is the calculation (established by our Congress in 1995 and then revised in 1997) wrong/outdated or are physicians doing the thing they hate most in the world way too much:  Clicking?  Generally, in these systems, if the physician just types away or even does the atrocious “Copy-and-Paste”, they’ll get a lower code level recommendation because the system can’t read the text and pick out what was done.

Every EMR salesperson uses the fact that physicians code at higher levels after an EMR implementation as a selling point to their system.  Because guess what?  EMRs are made to track medical procedures, not improve health or reduce the cost of medical care.  A sales pitch for an EMR could have been attended before writing a strongly-worded letter about their evils.  Benefits to having most healthcare providers on an EMR will be seen at the Public Health level in time, but who says that won’t come at a cost?  Until then, let’s just call them Electronic Medical Records, because our health is not related to how medical procedures are billed.  Maybe then we can tackle the fact that consumers have no concept of value when it comes to pricing medical procedures.  Or maybe we can address the fact that there are too many hands in the pot when it comes to a transaction and the communication between a physician and their patient.  Or maybe we could just teach certain people what things actually do before we put out incentives to use them.