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.'"
Medicare fraud is not new (Score:5, Interesting)
Medicare fraud is not new. It existed way before electronic records.
Florida's governor, Rick Scott's company committed medicare fraud way before electronic records were introduced.
Electronic records should make it easier to detect medicare fraud, as statistical analysis is much easier with computerized systems.
This is silly (Score:5, Interesting)
I gotta ask (since I'm far too lazy to read the article): Is this a lame attack on the existing administration?
Proper coding != fraud (Score:5, Interesting)
It's not clear to me that medicare providers changing their coding is the same as fraud. If a doctor was coding for a 10 minute E&M (evaluation and management) but was actually spending 20 minutes with the patient, then it's totally reasonable for them to change their coding. If EMRs are making it more obvious that the practice users are mis-coding, then this is at worst an unintended side-effect of the EMRs.
(Full disclosure, I work for a company that builds EMR systems.)
So the fraud is now exposed... (Score:4, Interesting)
My impression is that the US health care system has been doing this for as long as it has existed. Having digital records should be a great help to the insurance companies to make it easier to track down fraudulent health care providers.
Since I live in Sweden I don't usually have a problem with health care bills, but once during a vacation to the US I had to visit a hospital due to severe stomach pain. Four hours and a trip through the CT machine later I was released with a prescription for some pills. Six months later (back home in Sweden) a bill for $14000 arrives...
When I brought this to my insurance company and explained that the examination I went through couldn't possibly have cost that much they just shrugged and said "yeah, they always try this when dealing with foreign insurance companies". A few weeks later they had everything settled at just under $3000.
So what's the point of this story? If a system is open to exploitation you need someone to monitor it. Monitoring is easier with good records of what's been going on.
Re:Proper coding != fraud (Score:5, Interesting)
Now, the Australian company you declined to work for, they seem like the kinds of scum who hospital administrators might hire to commit wholesale fraud. That obviously would give rise to increased billing rates. If there's still a sliver of justice in the world, they'll go to jail for falsifying records.
Both the company providing the service and people enriched by using that service need to be held accountable.
Re:The real fraud... (Score:4, Interesting)
Not what my doctor says, though it is a plausible contributor to one of the problems he identifies. He's been paying malpractice insurance premiums for forty years and has been an expert witness in malpractice cases, so he knows what he's talking about.
He sees the problem as fueled by unnecessary procedures and caramelization (wow, that's a great autocorrect failure. I wrote cartel-ization). Unnecessary procedures might be caused by fear of litigation(*), or by a desire to milk the system.
Drug companies like to say that their prices are necessary to recoup research costs, but that doesn't explain doubling the price of a drug after it's already on the market. He's seen that happen.
Health insurance companies have lavish offices in expensive parts of downtown. They didn't get that money by being lean, scrappy competitors.
What he wants to see happen is single payer! That doesn't have to mean government, by the way. A nonprofit mutual insurance company is an option.
(*) If skipping a test might lead to a lawsuit, then skipping the test might lead to a patient getting hurt, in which case it's a necessary test.
Re:Just socialise the damn thing already (Score:4, Interesting)
Some valid points, but we already have socialized medicine and have for decades. It's called Medicare/Medicaid and a large segment does understand. Just try taking away those two programs from seniors and the AARP will be down on any politician that tries.
True, but the same logic that prevents us from throwing 4 year olds in jail for life for stealing candy bars (something that can and has happened in California to adults) also prevents us from packing old people into railroad box cars and disappearing them; There's simply no way we can rationalize it. We can't tell them to just "get a job", because, well... they can't work. It's obvious they can't work. It simply can't be denied. So, for those people whom we can't rationalize away their healthcare... we grudgingly give it to them. But only enough to keep them alive, not enough to be comfortable. I know many elderly who are in substantial pain. You think they're cranky because they're old? Not exactly -- They're cranky because they have a long list of medical problems, and only a short list of medical answers.
There was a guy recently who found out he had cancer -- a semi-famous member of the open source community (I disrecall the name). He was already disabled and on SSDI, but he made too much money to be on medicaid and wasn't old enough to get it automatically. He didn't have enough money for the surgery, which he needed in a matter of weeks. If he got it in time, his chance of survival with complete recovery was around 85%. Wait any longer, and he dies a slow, agonizing death. The government told him they wouldn't cover the surgery or any health care costs...
At least, not until he was declared terminally ill. Then they would pay for health care. That, sir, is the system we have today. There is nothing dignified about it, and most countries would consider such treatment not only barbaric, but a violation of basic human rights. It's not socialist medicine if the only reason its offered at all is because the alternative would result in social chaos and unrest costing more than the service offered. It's barbarism.