I was fascinated by a report published Sept. 22 in The New York Times headlined, “Medicare Bills Rise as Records Turn Electronic.” The article, written by Reed Abelson, Julie Creswell, and Griffin J. Palmer, used as its news hook a May 2012 Health and Human Services Office of the Inspector General (HHS-OIG) report titled “Coding Trends of Medicare Evaluation and Management Services.”
That report, authored by HHS-OIG Inspector General Daniel R. Levinson, had looked at a growing problem of abuse of electronic health record (EHR) capabilities for automating the copy-and-paste function for pieces of the patient record in order to enhance Medicare billing for evaluation and management in emergency departments, even when actually full-fledged evaluation and management (E/M) did not take place. As the OIG report states, “Between 2001 and 2010, Medicare payments for Part B goods and services increased by 43 percent, from $77 billion to $110 billion. During this same time, Medicare payments for evaluation and management (E/M) services increased by 48 percent, from $22.7 billion to $33.5 billion. E/M services have been vulnerable to fraud and abuse… The Centers for Medicare & Medicaid Services (CMS) also found that certain types of E/M services had the most improper payments of all Medicare Part B service types in 2008.
The Times article included interviews with Donald W. Simborg, M.D., who was the chairman of federal panels examining the potential for fraud with EHRs, and with Alan Gravett, M.D., who field a whistle-blower lawsuit against the Illinois hospital where we practiced, charging that that hospital’s EHR functionality made it far too easy to code and charge for full ED examinations that simply were not taking place. And, along with performing an independent analysis comparing Medicare payments to hospitals participating in the meaningful use program and those not yet participating (with that analysis finding a significant increase in billings among participating hospitals), the Times reporters noted that “Some experts blame a substantial share of the higher payments on the increasingly widespread use of electronic health record systems. Some of these programs can automatically generate detailed patient histories, or allow doctors to cut and paste the same examination findings for multiple patients—a practice called cloning—with the click of a button or the swipe of a finger on an iPad, making it appear that the physicians conducted more thorough exams than, perhaps, they did.”
What I found interesting about the Times article, which received front-page play, was the fact that the mainstream media, at least as evidenced by this and some other recent coverage, are now beginning to look at topics around EHR implementation in patient care organizations at much more granular levels, and beginning to question whether everything involved with such implementation is automatically positive in its impact. Don’t get me wrong: I would immediately add that the number of mainstream media outlets that will ever produce such thorough reporting, data analysis, and conceptual analysis as the Times did on Sept. 22, is never going to be very large.
But just the fact that such an article has appeared in the mainstream media is of interest, particularly since newspapers across the country use the Times wire service. And the implications of all this? Expect media scrutiny of healthcare delivery, payment, and policy issues to become ever-more-scrutinizing going forward. In other words, in the emerging era of the new healthcare, hoped-for characteristics such as transparency and accountability won’t just be abstract concepts; instead, providers will inevitably be examined under ever-finer-grade microscopes going forward.