Study: Despite Concerns, EHRs Don’t Increase Medicare Fraud
Concerns that nationwide electronic health record (EHR) adoption could lead to widespread fraudulent coding and billing practices that result in higher healthcare spending are unfounded, according to a study from the University of Michigan Schools of Information and Public Health and the Harvard School of Public Health.
Early results of the meaningful use program show that more than half of all eligible hospitals have qualified for financial incentives. However, some experts have suggested that the increased documentation abilities of EHRs could lead to practices like upcoding, in which care providers select billing codes that reflect more intensive care or sicker patient populations, or record cloning, which involves copying and pasting the same examination findings for multiple patients. Both these issues could drive up healthcare costs by documenting and billing for care that did not occur.
"There have been a lot of anecdotes and individual cases of hospitals using electronic health records in fraudulent ways. Therefore there was an assumption that this was happening systematically, but we find that it isn't," Julia Adler-Milstein, Ph.D., U-M assistant professor of information said. The study, by Adler-Milstein and Ashish K. Jha, Ph.D., Harvard professor of public health, is published online in the July issue of Health Affairs.
To examine these claims, the researchers analyzed longitudinal data to determine whether U.S. hospitals that had recently adopted EHRs had greater subsequent increases in the severity of patents' conditions and payments from Medicare, compared to similar hospitals that did not adopt. The research focused on hospitals that would be likely to change their coding practices: for-profit hospitals, hospitals in competitive markets, and hospitals with a substantial proportion of Medicare patients.
Despite widespread stories and concerns among policymakers about the potential for EHRs to increase fraudulent billing, the authors found that adopters and non-adopters increased their billing to Medicare at essentially identical rates. They found the same results among the groups of hospitals most likely to use electronic health records to increase coding and revenue.
The results also suggest that policy intervention to reduce fraud is not likely to be a good use of resources. Instead, the authors recommend that policymakers focus on ensuring that hospitals use EHRs in ways that are most likely to reduce healthcare spending and improve the quality of care.
