On Saturday, September 22, the New York Times published an article “Medicare Bills Rise as Records Turn Electronic.” The journalists raise a question on how the use of electronic health records may be linked to increased billing of clinicians seeing Medicare patients.
The article cites a May 2012 report published by HHS’s Office of the Inspector General entitled “Coding Trends of Medicare Evaluation and Management Services.” (Evaluation and management services is an umbrella term used to describe clinical encounters between clinicians and patients, such as, but not limited to, chief complaint, history of present illness, exam, etc.)
The OIG’s report studies the period of 2001-2010; during this time period, OIG analysts found that physicians increased their billing of higher level E/M codes in all types of E/M services. Between 2001 and 2010, Medicare payments for payments for E/M services increased by 48%, from $22.7B to $33.5B. The number of E/M services billed increased by 13%, from $346M to $392M; and the average Medicare payment amount per E/M service increased 31%, from $65 to $85.
As a result of its analysis, OIG presented three recommendations to CMS, of which CMS concurred with the first two, and partially concurred with the third:
- Continue educating physicians on proper billing for E/M services;
- Encourage CMS’s contractor to review physicians’ billing for these services; and,
- Review physicians who bill higher-level E/M codes for appropriate action. (CMS partially concurred with the third because it wasn’t sure if the benefits of reviewing such physicians would outweigh the costs incurred to conduct the reviews.)
Now, let’s jump over to the EHR Incentive Program. Signed into law in February 2009, CMS published final regulations for the program in July 2010. The first payments were made in May 2011. These payments were made to the 320 eligible professionals and eligible hospitals that attested in April 2011 – in the first two weeks that CMS opened attestation.
I strongly believe that it is good and right to have reputable journalists, such as those at the New York Times, asking probing questions about the use of EHRs and other health IT. As more hospitals and clinical practices across the nation adopt and begin using health IT, it is imperative that those efforts support a transformed health system that improves the quality, safety, and cost-effectiveness of care, as well as improving the access to care.
At the same time, I do take issue with the introductory paragraphs of the Times’ article, which propose a causal link between the EHR Incentive Program payments and the OIG’s findings. As the dates above describe, the OIG’s findings are not connected to the Incentive Program.
Still, it would be naïve of us to not realize that there is, as in all sectors of our economy, the potential for fraud and abuse. Hence, I appreciate the spot-light reputable journalists and committed HIMSS members shine when asking probing questions, and digging for the truth.
As we witness an upsurge in the adoption and use of IT by clinicians, patients, and others, HIMSS has already begun building what we call the “third leg of the stool” – equipping stakeholders to harness the power of clinical and business intelligence tools. Our Clinical and Business Intelligence Committee, chaired by Diane Carr, Deputy Executive Director with the North Bronx Healthcare Network, is focused on creating tools, resources, and education around knowledge management tools to support accountable and quality care, and teaching users how to derive valuable knowledge from health data. Such tools, used effectively, can uncover fraud and abuse.
We are also exploring the “dark side of the Force”; uncovering the nefarious, foolish, or harmful outcomes can come from the worst use of IT and management systems. We want all stakeholders engaged in the conversation – those who share our passion to positively transform healthcare through the best use of IT and management systems.
Let’s work together to uncover the unintended consequences of health IT, to develop solutions that can mitigate these consequences, to self-police, be open to constructive criticism, and learn from each other.
I welcome you to join us on our journey.