EMRs enable fraud--but is the technology itself to blame?

The debate over whether or not electronic medical records save the industry money continues with the latest volley: a recent analysis by the Center for Public Integrity that found electronic health records might lead to physician upcoding. In an NPR interview, Fred Schulte of the Center for Public Integrity expands on the study and the questions it raises, while national coordinator for Health IT Farzad Mostashari defended the federal push toward electronic records.

After looking at millions of individual Medicare billing records from the past decade, Schulte said, it became clear that doctors increasingly have been submitting bills for procedures that were more complex, took more time and paid them more money. At the same time, codes that paid less money diminished. "And then we started asking around as to, well, why is this happening?" he told NPR's Tom Gjelten.

"There doesn't seem to be a lot of evidence that patients are sicker, that patients are older, that there's that much change in what patients are coming to the doctor for. And what we heard in the industry, particularly with doctors and hospitals, is that electronic health records are responsible for this increase in coding," Schulte said.

Gjelten then turned his attention to Mostashari.

"Dr. Mostashari, you've heard this," he said. "What is the reaction in the Health and Human Services Department to this idea? I mean, these are pretty serious charges that the increased use of electronic medical records is actually leading to fraud."

Mostashari was quick to point out that much of the increased billing is appropriate. "You document more, you do more … higher-intensity visits, and the systems are able to capture that," he said. "As Don Berwick said, fundamentally, if you create a payment system where there's a premium for increasing the number of things you do or the recording of what you do, well, that's what you're going to get."

But is it the EMR itself that causes fraudulent behavior? Or does it simply make it easier for physicians who already are predisposed to commit fraud?

"There's always going to be people who commit fraud, and there's always going to be enforcement," Mostashari said. "It's important to note that we have taken … significant steps in increasing the enforcement against fraud. There's been a huge increase in the amount of identification of fraud and civil penalties and enforcement actions. And I think it's important to note that these tools also provide the means for stronger investigation and enforcement.

On Monday, the Obama administration issued a warning that it will not tolerate EMR-assisted fraud, such as cloning EMR notes or copying medical record entries from one patient's file to another's. The letter also mentions some hospitals may be using EHRs to upcode various procedures on patients, no doubt a reference to the Center for Public Integrity report.

The 50-minute conversation went beyond the cost of EHRs to include quality, coordination of care, automation and efficiency and more. Don Detmer, M.D., of the University of Virginia, Cleveland Clinic's Chief Medical Information Officer David Levin, M.D. and John Dooley, M.D., an internist at the Foxhall Group also joined in the discussion.

To learn more:
- read the full transcript of the show
- see the Center for Public Integrity report

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