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The EMR Harassment Brigade

Posted on January 9, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Today a piece appeared in the august New York Times which, frankly, got me a little bit steamed. You may feel the same way if you read it.

In the piece, two New York Times reporters cover a report issued by the HHS Office of the Inspector General looking at possible fraud and abuse among EMR users.  Apparently, the report concludes that CMS isn’t kicking EHR users hard enough.

To be fair, the OIG has enough disapproval to go around. In part, the report breathes fire down the neck of CMS, which, it notes has spent more time fostering EMR use then searching for fraud and abuse among the EMR user population.

But the report also seems to have railed against doctors and hospitals, which it says are using EMRs to upcode, especially (in the OIG’s eyes) by cutting and pasting text from one EMR record to another. This “cloning,” it suggests, may turn out to be a major source of fraud.

So what am I angry about?  Well for one thing, the article itself seems to by the implicit premise that cutting and pasting or other upcoding methods are widespread enough sources of fraud to deserve a full-scale investigation, and that CMS should direct a lot of its resources in this direction.  Guys, okay, I’ve been doing this a long time and I know better, whereas the Times reporters may not, but shouldn’t they have at least challenged the notion that EMR related fraud and abuse is a major problem?  You know, do some investigation?

The other thing that upsets me is the notion that overworked, stressed out EMR users — who have enough in their plate already — should be the ones who take it on the chin if their desperate attempt to keep up the pace do in fact result in the occasional upcoding incident.  Riding doctors can only further tax the surprisingly fragile state of affairs in EMR adoption.  And after spending more than 20 billion to accomplish something, is it worth endangering it to win a few brownie points with Congress?

HHS OIG Begins Digging Into EMR Overbilling Allegations

Posted on November 5, 2012 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Well, it had to happen: The furor over the possible EMR-related Medicare overbilling has moved to its next stage.  After enduring harangues by members of Congress and a widely-read New York Times article alleging that EMRs were upcoding machines, HHS has begun to look into the matter directly.

Fraud investigators within the HHS’s Office of the Inspector General have sent a 54-question survey to hospitals who got Meaningful Use incentive payments between January 1, 2011 to March 31, 2012. The survey looks into assertions that hospitals and physicians using EMRs have been inflating Medicare claims.

The logical next step for the OIG’s office is to issue a report to Congress spelling out whether it has reason to believe EMRs are linked to Medicare overbilling. The OIG will doubtless do some chart pulling and analysis to see whether it finds suspicious-looking patterns.

As I’ve said before — and will continue to say, doubtless — this whole effort concerns me. I’m not suggesting that HHS should ignore any evidence it has that hospitals or doctors are using EMRs to engineer a billing joyride. On the other hand, “overbilling” can be in the eye of the beholder, and conducting an inquisition into EMR user behavior seems premature to me.

I find myself wondering whether the feds have seriously considered hospitals’ response to these charges — that EMRs aren’t generating overbilling schemes, but instead are merely capturing and documenting services which weren’t always captured in the days of paper records.  It’s a credible argument and deserves a closer look.

So, let’s  hope HHS takes a breath and looks at the benign possibilities providers have outlined before it accuses hospitals and practices of wrongdoing. Otherwise, we’ll have a agency simultaneously pushing for EMR adoption and hanging the sword of Damocles over the heads of doctors and hospitals.