READERSWRITE
Recent news on the electronic health records meaningful use program generated a number of comments from Health Data Management readers. Sparking debate was GOP members of the House and Senate questioning the value of the electronic health records meaningful use program, and comments from a CMS official about Stage 2 patient information access requirements. Here are some reader reactions:
“Translation: We’re going to spend more taxpayer money to try
and find out why all the taxpayer money that we’ve already spent
has increased Medicare costs.”
“Clinics were also mentioned as a possible source of up-coding
by the House members. As the CEO of a Federally Qualified Health
Center, i.e. a ‘clinic,’ I would like to clarify that FQHCs are paid a
set rate for Medicaid and Medicare visits. Up-coding is of zero ad-
vantage to us as we will never get more than our rate for each vis-
it. I think the members of the House are unclear on both the com-
plexity of HIT technology and payment methodology for different
types of medical providers. Don’t tar us all with the same brush.”
“Up-coding possibly occurs. However, for years, paper chart-
ing has likely resulted in down-coding because of the complexity
of documenting all required aspects of the encounter and the ac-
companying fears of the providers concerning aggressive audits.
Electronic medical records have their faults and can be abused,
but they may also permit better and higher coding more appro-
priate to the work done. If the powers that be start throwing im-
pediments to charting and using electronic medical records, they
will risk further impairing productivity.”
“The probable reason codes are higher is because the EMR has
made it easier and faster for physicians to document everything
they actually did during a visit. Before, when a physician had to
dictate everything, it was not cost effective to take the time to docu-
ment everything that was done, or pay a transcriptionist to type it
all. I don’t think the government realized how much information
a physician gathers from taking a history and doing a physical
exam because for the above reason it was not recorded in the re-
cords in the past. The purpose for the medical record used to be for
the physician to make notes to jog his/her memory of the previous
visit in order to provide a continuity of care for a previously iden-
tified problem. Now, the record is used for multiple medically non-
pertinent reasons (as far as the individual patient is concerned),
such as justification for payment, quality measure reporting, legal
documentation and meeting regulatory demands.”
“We are being given rules and regulatiowns by people who have
never filled out a claim, billed an insurer or never went to medical
school. They have no idea or concept of what they are doing. Have
any of them ever spent a day or more in a real doctor office or
hospital admission office to see what it’s really like? I think this is
an area where they actually need to walk a mile in our shoes first.
It must be nice to be able to do what they do... if they don’t like the
game, they simply change the rules.”
“Dr. Coburn (senator from Oklahoma) says he still practices
medicine when he’s not in Washington. Does he use electronic
medical records or is he still a ‘paper’ doctor? Granted, serving in
Congress takes a lot of his time so he could not be the same type of
expert that a full time doctor would be … but does he or doesn’t
he? As I always say there’s nothing better than ‘hands on’ experi-
ence today when talking about any IT project.”
At the annual Medical Group Management Association conference, CMS official Travis Broome said the agency may “revisit”
the Stage 2 measure to have 5 percent of patients view/download/transmit their health information. He also noted the requirement was pushed by HHS Secretary Kathleen Sebelius.
“This is medical policy gone terribly awry. The HHS Secretary
and her policy advisors should change the requirement such that
it lays out what should constitute the minimum expected functionality of a patient portal without at the same time prescribing
any specific percentage of users. Demanding patients, whom
neither HHS regulates nor physicians control, to use portals and
simultaneously holding the threat of failing meaningful use tests
over the heads of physicians for not succeeding as social networkers is not only bad policy; it is also amazingly unintelligent and
high-handed.”
