Medicare Bills Rise As Records Turn Electronic 294
theodp writes "As part of the economic stimulus program, the Obama administration put into effect a Bush-era incentive program that provides tens of billions of dollars for physicians and hospitals that make the switch to electronic records, using systems like Athenahealth [note: video advertisement] (which made U.S. CTO Todd Park a wealthy man). The goal was not only to improve efficiency and patient safety, but also to reduce health care costs. But, in reality, the move to electronic health records may be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care. Hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms, according to a NY Times analysis. There are also fears that features which can be used to automatically generate detailed patient histories and clone examination findings for multiple patients make it too easy to give the appearance that more thorough exams were conducted than perhaps were. Critics say the abuses are widespread. 'It's like doping and bicycling,' said Dr. Donald W. Simborg. 'Everybody knows it's going on.'"
There's a problem on both ends (Score:5, Insightful)
The real fraud... (Score:5, Insightful)
...is how much health care costs in the first place.
Just socialise the damn thing already (Score:3, Insightful)
You know, I was reading an article where it stated that socialised medicine would cost *less* than what what it costs to run Medicaid and Medicare (on a per person basis)
You Yanks fear the word "socialist" so much you spend far more to get rid of it!
i apologize world, it is embarassing (Score:3, Insightful)
universal healthcare will result in longer lives and less healthcare spending in the usa. just like every other goddamn country with it
but, much like gun control, there is a certain feverish moron in my country that will never listen to reason on the subject, and he enabled by special interest groups in washington: the NRA and the healthcare insurers
maybe the feverish morons will shoot themselves and die waiting in the emergency room
Be fair (Score:4, Insightful)
Forgive my AC status, but for obvious reasons I can't divulge too many details. I was a contractor for a state government to facilitate writing an EHR system to integrate various state repositories for the purposes of the grants relevant to this story.
Of course this is going to cost more up front. We had to bring online hundreds of medical facilities who were operating with paper only with processes who's roots go back to the 1950s. The purpose of the grants was to MITIGATE the costs, not cover them completely.
The fact is that in the long run this will save money and is well worth the increase now. That increase would have been larger for every year longer we waited to bring some of these places into the modern era.
Fraud. (Score:5, Insightful)
Re:i apologize world, it is embarassing (Score:2, Insightful)
Re:Just socialise the damn thing already (Score:4, Insightful)
>
You Yanks fear the word "socialist" so much you spend far more to get rid of it!
You Wanks assume Yanks are all the same. That is not a valid assumption.
Re:Just socialise the damn thing already (Score:5, Insightful)
You Yanks fear the word "socialist" so much you spend far more to get rid of it!
You're parroting a commonly held misconception about how politics in the United States works. Firstly, your elected representatives come from more than two parties; Your voters have a wider diversity of candidates to choose from, and are less apt to vote along party lines. This also spreads out the concentration of money paid to your elected representatives by private interests. Put more simply, it's harder to buy legislation in your country. As well, the disparity between the rich and poor is far less pronounced. This results in your legislators being more likely to represent the actual will of the people, rather than the apparent or manufacturered will.
It's also no small matter that the UK has the BBC. It's more important than you guys give it credit for: The licensing fees you pay are amply repaid not just in terms of quality programming, but also unbiased programming. The BBC can't be co-opted with a corporate buyout. In our country, the media is largely controlled by a few dozen men like Murdock. An informed voter is a voter that can't easily be duped; And the BBC provides a mechanism to prevent your media from becoming too biased towards any one political view. Compare the US section of the BBC with any major news network here -- stories that make front page there, or are internationally relevant, simply don't make it. They aren't reported. It's not just that there's bias in what is reported, there's also things that the public simply isn't told about. You can probably deduce what this means for the political landscape.
Lastly, the UK was bombed into near-nothingness. The US never has been. The closest we've come to having to reassess economically was the Great Depression. Because we never had to rebuild from scratch, we never learned the social lessons that an experience like that offers -- specifically, we never really developed a cultural center of "We're all in this together". American culture has long been based on individualism -- which during times of material prosperity is great, but during economic trouble, it creates a "blame the victim" mentality. You are poor because you want to be poor, not because some bad shit just happened to drop on your head. The American Dream has become a political crucible -- maintaining our collective ego has forced us into social policies that are ultimately harmful and destructive to our way of life. It's a societal-scale version of the Just World phenomenon.
It's not socialism per-se that we're afraid of -- it's the idea that we aren't in control of our own fate. That we aren't individuals, but actually part of something more than ourselves, and that our success is determined only in part on our own choices, rather than entirely by it. It's ego protection, individually and collectively. And when you read anti-socialist opinions in our media, they may use the same words you know and understand, but they don't mean the same things. It all goes back to the cold war, the super power stuff, and that collective ego I mentioned earlier.
For us, socialism is a sign of weakness; It's a sign that we've become like the russians, the iranians, and all the other boogie men we've bomed the hell out of. So even when it would be good and proper for us to adopt socialist social policies, we don't... we'd rather go on maintaining the notion that We're Number One. America is on a path of self-destruction because it simply can't acknowledge, individually or collectively, that we need help and we need to work together. Our problems are world problems too -- but until that fact ingrains itself into our culture, it's pointless to expect change. America, as an idea and as a culture, would rather die than admit defeat.
Just like the British did at the height of their empire. It's a phase we'll outgrow eventually, just like you guys did. But it won't happen quickly, or easily, or gracefully.
Re:The real fraud... (Score:5, Insightful)
The Real Fraud is how much health care costs in the first place.
The main reason for that is simple. Insurance and Litigation
1) You Need Insurance to get healthcare, because healthcare costs too much.
2) Your Doctor Needs Insurance because you might sue him for malpractice, the state he's in requires it, or both, Raising the cost of healthcare.
3) The pharmaceuticals your Doctor prescribes you needs Insurance because you might sue them for complications. Raising the cost of healthcare.
4) Your Hospital needs insurance because you might sue them for hiring the doctor that you sued for malpractice, or because he prescribed you something that didn't work, or the state they are located in requires it or a combination of all of the above. raising the cost of healthcare.
5) The ambulance chasing lawyer on TV needs more money to buy TV commercials to help you, so he sues the insurance companies of your doctor, the pharmaceutical company, and your hospital for malpractice, so you get the 5-25% of the total compensation that you deserve and he pockets the 75%-95% to pay for his paper costs and time, which of course, Raises the cost of Insurance, which in turn raises the cost of healthcare.
1) Repeat step 1
Until we get a president and congress that will pass healthcare reform that will truly end this cycle for good, expect your health costs to skyrocket.
you're ignorant beyond belief (Score:5, Insightful)
a free market in real life translates to "give as many expensive tests as we can get away with"
healthcare isn't a MARKETPLACE. it is not driven by best price, because the buyer has no control to seek the cheapest service. no knowledge of medicine. no time when he is having a heart attack to shop around
face reality: there are some issues in life, where, believe it or fucking not, market forces do not help, and make things worse
i say this as a committed capitalist. capitalism works. but i'm not a looney tune frothing at the mouth ignorant free market fundamentalist who believes the magic unicorn and rainbows marketplace is a magic elixir that solves all problems. it doesn't
Re:Proper coding != fraud (Score:5, Insightful)
Different problem (a real problem but a different problem).
The big issue here is how the billing codes are set up for physician encounters. You determine the code (and hence the charge) with a laundry list of things - how many issues you covered in your interview, how many parts of the body you examined, how much extra detail you went into (family history, smoking history and the like).
Then you get brownie points for medical complexity.
So, you add all of this up and you get your E&M code (Evaluation and Management). Now, in the olden days you had to manually keep track of how many 'points' you were wracking up. Amazingly enough, computers can add! So the program keeps track of all the little points and thus can maximize the code. Extra bonus points for the program 'helpfully' pointing out a few things you might have missed (did you ask about smoking? Vaccines?) - you can then go back and do them (or at least say that you did) and up code.
The other problem is cut and paste - you can take the Past Medical History of the patient and copy it from one encounter to another. Now, that seems perfectly reasonable - you WANT to know this stuff, it's important and that's why you take the time to write it down. However, you don't need to go through a 45 minute interview with the patient ever time you see them - but that's what the billing codes assumed you did. Now Medicare has decided if you copied the old data that's "fraud".
Basically, you have a clumsy, prehistoric system for coding physician encounters that has been computerized without much thought as to what happens after the fact.
One of my favorite aphorisms in this arena is "Computerizing chaos yields computerized chaos."
Re:The real fraud... (Score:2, Insightful)
Even if you factor all of that in, it probably represents something like 20-30% of the 'extra' costs in US medicine. It's a significant and important aspect of the problem, but it's not the sole nor major driver.
Briefly you have:
- The issue of 'defensive medicine' as you point out.
- The issue that much of US medicine is set up as a for profit entity with expectations of increasing growth and profits. Many of the big players are heavily leveraged.
- The multiple sacred cows - physicians, insurers, hospitals and, not least, patient expectations (I want that MRI and I want it NOW).
- And the fact that it's a highly complex, labor intensive field.
Hard to fix something that crazy.
Re:Is this a lame attack on the current admin.... (Score:2, Insightful)
You lose credibility when you call the largest television news network, owned by the largest media company, non-mainstream.
Re:you're ignorant beyond belief (Score:4, Insightful)
I feel your pain. I read through this and can see talking point propaganda every step of the way. It baffles the imagination that such mindesets can exist in the modern information age. But wait, it will only get worse. Notice the use of the term "Marxist". It's a buzz word for them, it allows them to excuse their actions and thoughts towards those that don't agree with them. It's a mob mentality that wants to take a baseball bat to your head in a fit of rage.
They have been fed hate filled nationalistic "religion" based propaganda by "hate radio" and Faux News for years now. This is carefully cultivated and well crafted propaganda that Goebbels would get an erection over. As this election draws nearer and the pressure builds exponentially in the days before and after it, this propaganda will come to fruition. Regurgitating the lies will not suffice and we will see violence from this ilk like this country has never seen. You can smell the madness between the lines even now.
For every action there is an equal and opposite reaction. Weapons grade propaganda doesn't just vanish like smoke when the politicians and their puppet masters are done spewing it on the masses. There are minds steeped in it, poisoned with hate; there are consequences.
Re:i apologize world, it is embarassing (Score:4, Insightful)
Why do you maintain that socialized medicine is a bad thing when all the evidence suggests that the opposite is true? Are you equally critical of America's use of socialized police and fire departments?
Re:Medicare fraud is not new (Score:5, Insightful)
I have no problem at all with free healthcare providing a safety net for those who can least afford it. Indeed, I find the escalating costs of the US's private health insurance system quite scary and it is not sustainable at all. However, if you're going to have a publicly backed health system then have it within a public sector organisation with a proper mandate. Mixing public sector planning with public sector printed cash and the private sector simply results in private companies and those who make public sector buying decisions getting drunk on printed cash at taxpayer's expense. The whole fraudulent system is based around how big everyone feels they can make the numbers on their invoices because they know the government can always print more, and everyone knows that is the case with Medicare.
Re:This is silly (Score:5, Insightful)
OK, a lot of this came about due to HIPPA, the Health Information Portability and Privacy Act. At the time HIPPA went into effect, private insurance paperwork ('administration costs') for medical costs were running 30-35% of every healthcare dollar spent, while with Medicare, the paperwork costs were only about 3%. It wasn't too bad of an idea, considering we're dealing with the Feds here, and rather visionary at the time. This of course was while the Feds were still directly administering Medicare/Medicaid, before they privatised it out on 'cost-plus' contracts. The intent at the time was to reduce paperwork/administration costs to something comparable to what Medicare was doing, i.e., dirt cheap, to reduce healthcare costs. At the time, it was a good idea.
Standardising medical records and insurance forms along Medicare lines meant the girl in the billing office only needed to really understand one form and how to fill it out, where before, each healthcare insurance company could use their own proprietary form, and change said form at will to delay payment of claims. Hey, this kinda shit happened a lot in the 80's, peaked in the 90's, and basically added the gasoline to the fire that caused HIPPA to happen. Back then, they didn't use your Social Security number as identification, but as an account number for your Medicare and/or Social Security/SSI/disability check and to make sure your Social Security account was properly funded for you. In fact, back then, they even printed on the bottom of your Social Security card 'NOT TO BE USED FOR IDENTIFICATION'. (BTW, that came off your SS card some time ago.) It was cool because they weren't using your SSN for anything else, your credit report and such wasn't indexed by it, and the only way to get somebody's SSN was to steal their wallet and look at their card. Then the laws changed.
Now, your SSN is used for identification. It's tied to your credit report, your SS/Medicare account (which has a seperate account number now), yadda yadda yadda. Kids are issued SSNs at birth, where before, when I was a kid ('Get off my lawn!!!'), you filed for your SSN when you landed your first job or enlisted in the military. You file for your kids, the Social Security Administration would look at you and tell you they had laws in this country against child labor.
Anyways, the intent was to cut healthcare costs by cutting paperwork & administration costs. Then Medicare got privatised. And where they once had 3% admin costs, they were soon up to the 'standard' 30-35% costs of 'regular medical insurance'. The medical insurance companies had standards dammit, and they weren't gonna let Medicare exceed them. Especially not when there was a few billion bucks to be made. What needs to happen is, healthcare should be a government funded monopoly, paid for from your taxes. It's in the government's interest to do this. Access to healthcare means a healthier citizenry, with less time lost from work due to illness. It also means lower healthcare costs overall because little problems get caught before they become big expensive life-threatening/altering problems. See the Chinese 'barefoot doctor' program for further information, and let's marry that concept to a Canadian/UK/Scandanavian model single-pay system.
Re:Medicare fraud is not new (Score:4, Insightful)
Yup, 40% definitely seems high based on the ton of medical bills I've seen paid.
I love it when people say that if you pay cash the doctor will give you a big discount since it saves them a lot of hassle. The big discount turns out to be "OMG 40% off retail!!!" That means that you're paying 60% of retail, or likely double what any insurance company would pay.
If I were in charge of health care reforms the first reform I'd enact is that EVERYBODY pays the same thing for the same service. Doctors would register their prices by ICD9 or whatever in some central database, which would be publicly viewable. Oh, and doctors wouldn't be able to collect a penny without having an estimate signed off before any work was done - just like how virtually every other industry works. Oh, and while you're at it if the customer isn't handed a copy of the chart on the way out the door, then the work is free.
Re:Medicare fraud is not new (Score:5, Insightful)
Also, the 'issue' at hand is about $3.33/citizen. That means its a tornado in a teacup like th 12 milion dollar muffins.
300BN fighter jet programs are $1000/citizen, and considering our absurd power, are much more worth PRIORITIES in what may be a 'issue' of waste.
Re:Medicare fraud is not new (Score:4, Insightful)
No doubt. But I live in the wonderful USA, where medical billing is like people haggling over a Honda Civic and the dealer is asking for $400k, and the fleet buyer is looking to spend $19.95 but pays $10k, and the dealer tells some poor bum who walks in off the street that because they're in so much need that they can have the car for only $80k.