Comments on: How the widespread adoption of electronic medical records can raise health care costs http://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html Wed, 15 Feb 2012 00:27:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html#comment-90270 Anonymous Sat, 14 Mar 2009 00:37:00 +0000 http://clients.emmense.com/kevinmd/2009/03/how-the-widespread-adoption-of-electronic-medical-records-can-raise-health-care-costs.html#comment-90270 The end net effect on fees per visit will be neutral due to payment adjustments as noted above.<br/><br/>The real effects on cost will occur as a result of any impact on what services are provided:<br/><br/>Reduction of duplication: reduced costs<br/><br/>Increase in guideline recommended testing that now isn't done by neglect or sound clinical judgement: increased costs.<br/><br/>Net: Who knows? Certainly not the policy wonks who pulls predictions out of the air. The end net effect on fees per visit will be neutral due to payment adjustments as noted above.

The real effects on cost will occur as a result of any impact on what services are provided:

Reduction of duplication: reduced costs

Increase in guideline recommended testing that now isn’t done by neglect or sound clinical judgement: increased costs.

Net: Who knows? Certainly not the policy wonks who pulls predictions out of the air.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html#comment-90255 Anonymous Fri, 13 Mar 2009 10:59:00 +0000 http://clients.emmense.com/kevinmd/2009/03/how-the-widespread-adoption-of-electronic-medical-records-can-raise-health-care-costs.html#comment-90255 as i understand billing, dr sucher's comments about low level decision making precluding upcoding are not wholly accurate. there are a number of e/m codes which only require 2/3 key components so expanded physican exams may help 'upcode' a bill<br/>of course his comments about unethical professionals not needing an emr to game the system is dead on.<br/><br/>we are currently implementing an emr in the office. it is terrible frankly. really expensive way to decrease physican efficiency and decrease overall patient volume so far. decreased patient satisfaction as well. also had to hire more staff to scan in information. <br/>ymmv. as i understand billing, dr sucher’s comments about low level decision making precluding upcoding are not wholly accurate. there are a number of e/m codes which only require 2/3 key components so expanded physican exams may help ‘upcode’ a bill
of course his comments about unethical professionals not needing an emr to game the system is dead on.

we are currently implementing an emr in the office. it is terrible frankly. really expensive way to decrease physican efficiency and decrease overall patient volume so far. decreased patient satisfaction as well. also had to hire more staff to scan in information.
ymmv.

]]> By: Joseph Sucher, MD FACShttp://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html#comment-90252 Joseph Sucher, MD FACS Fri, 13 Mar 2009 02:36:00 +0000 http://clients.emmense.com/kevinmd/2009/03/how-the-widespread-adoption-of-electronic-medical-records-can-raise-health-care-costs.html#comment-90252 Dr. Pho,<br/><br/>This is the third sensationalist headline in a month. Great work. I took the bait and read it. I also read the link to your article in USA Today which was more even minded. Additionally, I read Dr. Haig's article which lamented the bad points of computerization.<br/><br/>I think that the vast majority of computerized healthcare systems are in fact poorly designed and have created as many problems as they have helped solve. There are two sides to this one-sided post of yours, and this is my point for calling your post sensationlism.<br/><br/>"The slightly embarrassing financial reality of EMR" is no more an EMR phenomena than our day to day lives of filling out forms and dictating H&P's. To say that EMR has any more to do with the broken system of documentation for the sake of financial remuneration is simply naive. In fact, since it is unlikely that our documentation will be decoupled from billing, the EMR is the only solution to help decrease our burden and help the physician get back to work. Unfortunately the embarrassing truth is that we are more the servant of these current systems than they our to us. This is the real problem that needs to change.<br/><br/>The whole "upcode" argument is freshman and unprofessional. Again, this has nothing to do with EMR. Plenty of unscrupulous physicians fraudulently coded long before EMRs, and they will continue to do so after. And to suggest that someone will change a diagnosis to something of more complexity because of EMR is ludicrous. A physician can do this on paper just as easily.<br/><br/>Finally, in the example of going "to the doctor with a sore knee..." Doesn't hold water at all. The final E&M encounter doesn't get any higher billing no matter how many systems you examine as long as the medical decision making component isn't complex. So therefore you can document all about the ear, the EMR system won't help you upcode to something that can't be upcoded. It in fact will show you that you wasted your time.<br/><br/>So, be careful what you post about digital records. "Gaming the system" is a problem with unethical un-professionals. It has nothing to do with EMRs.<br/><br/>Finally, why trash the reputation of EMRs as they relate to billing? I guess we should just keep our current systems of generating form after form, that we need to fill out for the insurance companies to deny. Let's keep our 120 day A&Rs. Let's keep the plausible deniability. Let's ensure that our patients get bills that are completely undecipherable. Let's keep the systems that a patient receives bills for months and even a year after being in a hospital. If we have to deal with a system of bills based off documentation, then I for one need an EMR (at least one that works). That's the real problem... we need these systems to work more for us and us work less for them.<br/><br/>JFS Dr. Pho,

This is the third sensationalist headline in a month. Great work. I took the bait and read it. I also read the link to your article in USA Today which was more even minded. Additionally, I read Dr. Haig's article which lamented the bad points of computerization.

I think that the vast majority of computerized healthcare systems are in fact poorly designed and have created as many problems as they have helped solve. There are two sides to this one-sided post of yours, and this is my point for calling your post sensationlism.

"The slightly embarrassing financial reality of EMR" is no more an EMR phenomena than our day to day lives of filling out forms and dictating H&P's. To say that EMR has any more to do with the broken system of documentation for the sake of financial remuneration is simply naive. In fact, since it is unlikely that our documentation will be decoupled from billing, the EMR is the only solution to help decrease our burden and help the physician get back to work. Unfortunately the embarrassing truth is that we are more the servant of these current systems than they our to us. This is the real problem that needs to change.

The whole "upcode" argument is freshman and unprofessional. Again, this has nothing to do with EMR. Plenty of unscrupulous physicians fraudulently coded long before EMRs, and they will continue to do so after. And to suggest that someone will change a diagnosis to something of more complexity because of EMR is ludicrous. A physician can do this on paper just as easily.

Finally, in the example of going "to the doctor with a sore knee…" Doesn't hold water at all. The final E&M encounter doesn't get any higher billing no matter how many systems you examine as long as the medical decision making component isn't complex. So therefore you can document all about the ear, the EMR system won't help you upcode to something that can't be upcoded. It in fact will show you that you wasted your time.

So, be careful what you post about digital records. "Gaming the system" is a problem with unethical un-professionals. It has nothing to do with EMRs.

Finally, why trash the reputation of EMRs as they relate to billing? I guess we should just keep our current systems of generating form after form, that we need to fill out for the insurance companies to deny. Let's keep our 120 day A&Rs. Let's keep the plausible deniability. Let's ensure that our patients get bills that are completely undecipherable. Let's keep the systems that a patient receives bills for months and even a year after being in a hospital. If we have to deal with a system of bills based off documentation, then I for one need an EMR (at least one that works). That's the real problem… we need these systems to work more for us and us work less for them.

JFS

]]> By: Rishihttp://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html#comment-90249 Rishi Fri, 13 Mar 2009 01:17:00 +0000 http://clients.emmense.com/kevinmd/2009/03/how-the-widespread-adoption-of-electronic-medical-records-can-raise-health-care-costs.html#comment-90249 From a market perspective, this would probably be a great time to invest in Cerner (NASDAQ: CERN) - the lead supplier of healthcare technology in the United States. From a market perspective, this would probably be a great time to invest in Cerner (NASDAQ: CERN) – the lead supplier of healthcare technology in the United States.

]]> By: Manalivehttp://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html#comment-90248 Manalive Fri, 13 Mar 2009 01:11:00 +0000 http://clients.emmense.com/kevinmd/2009/03/how-the-widespread-adoption-of-electronic-medical-records-can-raise-health-care-costs.html#comment-90248 EMRs slowed our ER to a crawl; nurses, techs, doctors - everyone is typing. Patients notice this and are unhappy.<br/>Office-based docs like me who dictate our notes will see fewer patients per day with EMRs - not more.<br/>EMRs are a bad idea whose time has come. EMRs slowed our ER to a crawl; nurses, techs, doctors – everyone is typing. Patients notice this and are unhappy.
Office-based docs like me who dictate our notes will see fewer patients per day with EMRs – not more.
EMRs are a bad idea whose time has come.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html#comment-90244 Anonymous Thu, 12 Mar 2009 23:30:00 +0000 http://clients.emmense.com/kevinmd/2009/03/how-the-widespread-adoption-of-electronic-medical-records-can-raise-health-care-costs.html#comment-90244 Will it be easier or more difficult to audit a provider who uses EMRs? Upcoding -as in the example given - from 599.0 (UTI, site not specified) to 590.80 (pyelonephritis, unspecified) might fly under the radar for a while. A pattern of higher utilization of codes not normally used by a particular provider, practice, etc. will raise a red flag somewhere, whether it is with an insurance company or the OIG. Should one hope that the EMR vendor has programmed in the other stuff the provider needs to look at and document to justify the diagnosis "upgrade", hope that such a practice doesn't become as automatic as clicking through meaningless medication interaction warnings, or hope for something else? What hasn't been discussed is faulty diagnoses following a patient around like a black cloud. (Echoes of my ICD-9 instructor commenting on commonly miscoded test items - Why did you give the patient a disease he doesn't have?) Will it be easier or more difficult to audit a provider who uses EMRs? Upcoding -as in the example given – from 599.0 (UTI, site not specified) to 590.80 (pyelonephritis, unspecified) might fly under the radar for a while. A pattern of higher utilization of codes not normally used by a particular provider, practice, etc. will raise a red flag somewhere, whether it is with an insurance company or the OIG. Should one hope that the EMR vendor has programmed in the other stuff the provider needs to look at and document to justify the diagnosis “upgrade”, hope that such a practice doesn’t become as automatic as clicking through meaningless medication interaction warnings, or hope for something else? What hasn’t been discussed is faulty diagnoses following a patient around like a black cloud. (Echoes of my ICD-9 instructor commenting on commonly miscoded test items – Why did you give the patient a disease he doesn’t have?)

]]> By: Sgenthttp://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html#comment-90242 Sgent Thu, 12 Mar 2009 22:57:00 +0000 http://clients.emmense.com/kevinmd/2009/03/how-the-widespread-adoption-of-electronic-medical-records-can-raise-health-care-costs.html#comment-90242 This "might" be an issue for some physicians, but the documentation of normals (as explained by Roger) has been done for decades using paper templates -- which are also allowable according to Medicare rules. This “might” be an issue for some physicians, but the documentation of normals (as explained by Roger) has been done for decades using paper templates — which are also allowable according to Medicare rules.

]]> By: David A.http://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html#comment-90241 David A. Thu, 12 Mar 2009 22:56:00 +0000 http://clients.emmense.com/kevinmd/2009/03/how-the-widespread-adoption-of-electronic-medical-records-can-raise-health-care-costs.html#comment-90241 Roger's comments are right on, and he adds "And the only way to fix them is to pay physicians for the care they provide, not how many items they document."<br/><br/>I would add that the only way to fix the payment system is to have patients pay physicians directly. Eliminating the routine use of third-party payers is at the heart of fixing the current system. Roger’s comments are right on, and he adds “And the only way to fix them is to pay physicians for the care they provide, not how many items they document.”

I would add that the only way to fix the payment system is to have patients pay physicians directly. Eliminating the routine use of third-party payers is at the heart of fixing the current system.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html#comment-90238 Anonymous Thu, 12 Mar 2009 22:32:00 +0000 http://clients.emmense.com/kevinmd/2009/03/how-the-widespread-adoption-of-electronic-medical-records-can-raise-health-care-costs.html#comment-90238 Payors will merely reduce the payment for each code.<br/><br/>As the codes shift higher, then the higher codes will get payment at the rate that the lower code used.<br/><br/>Check and mate. Payors will merely reduce the payment for each code.

As the codes shift higher, then the higher codes will get payment at the rate that the lower code used.

Check and mate.

]]> By: yoshhttp://www.kevinmd.com/blog/2009/03/how-widespread-adoption-of-electronic.html#comment-90237 yosh Thu, 12 Mar 2009 21:49:00 +0000 http://clients.emmense.com/kevinmd/2009/03/how-the-widespread-adoption-of-electronic-medical-records-can-raise-health-care-costs.html#comment-90237 Just goes to show that we need electronic medical records AND physician payment system reform! Just goes to show that we need electronic medical records AND physician payment system reform!

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