Concerns that electronic health records will result in an uptick in Medicare payments to hospitals – for legitimate or fraudulent reasons – appear to be unfounded.
Anecdotal reports have surfaced in the wake of a federal incentive program to push for the adoption of EHRs that hospitals might be using the systems to boost payments by more accurately capturing, and more accurately charging, for services rendered than previously recorded, by "upcoding" or selecting billing codes that reflect more intensive procedures or reflect a sicker patient population, or by simply "cloning" entries into an EHR to provide higher billing to multiple patients that might not reflect the care provided. These reports have led the Department of Health & Human Services Office of Inspector General to call for Medicare administrative and program integrity contractors to do more to detect potential fraud from the use of EHRs.
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EHR fraud may not be as prevalent of an issue as initially expected, said Dr. Adler-Milstein and Dr. Jha.
However, research by Julia Adler-Milstein, Ph.D., of the University of Michigan, Ann Arbor, and Dr. Ashish Jha of the Harvard School of Public Health, Boston, suggests that this kind of fraud has not been an issue.
"We found that hospitals that adopted EHRs increased billing to Medicare, but at a rate comparable to that of matched controls of non-EHR adopters," the researchers wrote in the article appearing in the July issue of Health Affairs (July 2014 [doi:10.1377/hlthaff.2014.0023]).
Researchers looked at 393 hospitals that had newly adopted a basic EHR (181 that adopted between 2008 and 2009 and 212 that adopted between 2009 and 2010) and compared them to 782 control hospitals that did not adopt during the same periods. New adopters were predominantly nonteaching (61%), for-profit (70%), and medium-size (47%) hospitals.
In the research models, "we found no significant relationship between EHR adoption and patient acuity," the report states. Also, "adopters and controls had indistinguishable changes in Medicare payments. Between the pre- and postadoption periods, payment per discharge to adopters grew by $849 and to controls by $945. This $96 difference in difference was not in the predicted direction, but it was not significant, either (P = .673)," the researchers wrote.
They suggested that the results were due to hospitals heavily investing in optimizing coding before adopting EHRs.
"Hospitals operate on thin financial margins and therefore likely work hard to maximize reimbursement," the researchers wrote. "Thus, simply having more electronic data or better documentation may not provide as much of an opportunity to increase coding as has been postulated."
They concluded that while there will always be outliers that engage in fraudulent behavior, "our findings suggest that a large-scale policy effort targeting EHR-driven fraudulent coding, such as the one recently recommended by the HHS Office of Inspector General, is not likely to be useful. Substantial savings are unlikely to result even from a policy targeting certain subgroups of hospitals that might be expected to experience the greatest pressure to increase billing after investing in an EHR system."