Medicare costs: Are electronic records the solution—or the problem?
Electronic billing has been promoted as a big cost savings for healthcare. But is it? The Center for Public Integrity has challenged the conventional wisdom, and the rest of us would do well to pay attention. For 20 months, CPI combed Medicare records and talked to providers, billing consultants, and others to document one big reason for the growth in Medicare spending over the last decade: Doctors and hospitals are sometimes “upcoding,” or charging Medicare for higher levels of services when they didn’t provide it, while hospital emergency departments too are grabbing billions in extra fees for their services.
A couple of startling findings: 1) “More than 7,500 physicians billed the two top-paying codes for three out of four office visits in 2008, a sharp rise from the numbers of doctors who did so at the start of the decade.” 2) “Use of the top two most expensive codes for emergency room care nationwide nearly doubled from 25 percent to 45 percent of all claims during the time period examined. In many cases these claims were not for treating patients with life-threatening injuries. Often they (patients) were treated for seemingly minor injuries and complaints.”
In response to the CPI investigation and the Times story, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius sent a letter to five major hospital trade groups, warning about fraudulent use of electronic medical records to inflate Medicare bills. The move strikes me as slap-on-the-wrist response to a significant and costly problem, and it certainly bears follow-up from the media.