Wednesday, October 03, 2012

Abuse of EMRs? Really - Let's Take a Closer Look!

The New York Times recently published an article called "Abuse of Electronic Medical Records", in which they started off by saying "The Obama administration has issued a strong and much-needed warning to hospitals and doctors about the fraudulent use of electronic medical records to illegally inflate their billings to Medicare."

REALLY?!?!   Let's take a closer look:  First, the evidence is that billings and coding has gone up over the past 5 - 10 years, and EMR vendors tout better billing as one of their benefits.   Hmmm... that's not exactly a smoking gun.

But fair enough, so let's review why we might get increasing billings and coding:

1. The EMR makes it easier to code appropriately.  I hate when they say "upcode", which implies fraud.  Rather, I think that many doctors (especially primary care and other non-proceduralists) have undercoded for years... and the EMR actually allows them to document all the "thought work" they have been doing for a long time.  The E/M system was designed to help value "thinking doctors" - and it's starting to work!  Let's applaud that, not try and make it sound like fraud.

2. The EMR allows docs to do more at a single visit.  I think this is an often overlooked reason to explain what has happened.  I know in my practice that having an EMR allows me to get to more things in a single visit than in a paper-based system.  So without an EMR, if a patient came in for a sprained ankle - I might just take care of that and told them to come back for their other issues.  With an EMR, it makes it easier to see everything at once and manage multiple issues.  This is an incredibly GOOD thing for the patient, and for the system - since one "bigger visit" (e.g. "Level 4") is cheaper and more efficient than two "smaller visits" (e.g. Level 3).   So maybe the government should not just look at billings, but also at the total number of visits a patient had - and see if that decreased over the past 5 - 10 years... maybe because docs were doing more work in less visits!

Oh wait, they did do this!?  One of my favorite blogs (HISTalk) actually ran this snippet of info today: The Census Bureau says adults under age 65 made an average of 3.9 visits to physicians in 2010, down from 4.8 visits in 2001. Possible explanations: more uninsured, fewer physicians, higher patient costs, innovation that allows providers to accomplish more in a single visit, and more meds available without a prescription.  So maybe the attorney general and HHS could talk to their own colleagues a bit more before throwing around accusations slandering docs who use EMRs?

3. Docs are using EMRs to defraud the government.  Obviously, there will always be some small amount of doctors who commit fraud - whether that is on paper or EMRs... but I certainly don't think that using an EMR all of a sudden makes doctors more fraudulent.  And by the way, since this fraud is happening in both paper and IT systems... I'd appreciate if our government didn't just pick on EMRs, and said something like this instead:   "We know most doctors are outstanding citizens who give of their time to help others, but there are a few who commit fraud... and whether they do so on paper or EMRs - we will find them and prosecute them!  And while healthcare IT may make it easier for some to perform some fraud, it also makes it easier for us to catch them - so watch out bad guys!" 


  • Coding: Up, Down or Around? I'm quoted in this HDM article - basically saying EMRs make us more efficient docs and better coders (in contrast to the HHS report trying to make EMRs sound like fraud machines)!


  1. I find all of this hard to believe, but can understand how it could be abused. My office uses a very tightly controlled physical therapy billing system. It is not in anyway a bad thing or something that can be abused. All of our records are sent to the government annually and are analyzed closely. We honestly have no room for error when using this system.