HealthData Management - February 2013

editor’s

NOTE

The Chickens Come Home to Roost

The federal government and other health care players are hell-bent on improving efficiency, but it’s looking like one man’s efficiency is another man’s upcoding.

This month’s cover story (page 20) brings us once more to the crux of the issue electronic health records represent for their Big Picture proponents. Can, or will, EHRs actually help the U.S. health care industry curtail costs, when they provide such a powerful tool for physicians to bill more for the care they provide?

Editorial Director Gary Baldwin first wrote about this in a June 2011 cover story, “The $80 Billion Question,” in which physicians and industry leaders debated whether the savings in the “right” efficiencies—fewer redundant tests, better managed chronic conditions, fewer medical errors—would offset what budget hawks would probably deem the wrong ones: rising reimbursements thanks to the vastly improved charge capture and documentation capabilities provided by EHRs.

Having reported on this industry for more than a decade, I can confidently say that providers of all stripes will agree that HHS and private insurers have made billing so incredibly complex that they’ve virtually guaranteed the failure of caregivers to accurately—and “efficiently,” that word again—document and bill for services provided.

For years hospitals and private practice physicians have been writing off a distressingly large chunk of their billings because

they couldn’t document to the level required by payers, or they just gave up trying to get compensated because of the enormous amounts of time it required to contest rejected claims.

No doubt there may be some upcoding going on, but much of the documentation that HHS deems as “ up-coding” is debatable on that point; the outright fraud— such as claims filed for nonexistent services—going on is another matter that doesn’t need to enter into this discussion.

So the chickens really have come home to roost. Providers facing a never-ending assault on reimbursement rates are using technology that many grudging adopted under pressure to do what they’re required to do—get data on every “touch” on a patient. HHS on one hand applauds and rewards those automation efforts, while on the other it questions the newfound documentation prowess of providers.

Whether EHRs will bend the cost curve is really the question. The efficiencies are starting to feel real in patient care, but the national expenditures keep rising toward disaster. Here’s hoping that digitization is indeed setting us on the path toward improved population health, properly aligned incentives and a lower-cost health system.

EDITOR-IN-CHIEF Greg Gillespie greg.gillespie@sourcemedia.com (773) 561-7372

EDITORIAL DIRECTOR Gary Baldwin gary.baldwin@sourcemedia.com (312) 777-1363 NEWS EDITOR Joseph Goedert (231) 755-0805 joseph.goedert@sourcemedia.com CONTRIBUTING EDITOR Elizabeth Gardner ART DIRECTOR Scott Valenzano EDITORIAL DIRECTOR, PROFESSIONAL SERVICES GROUP John McCormick PUBLISHER Tony Carrini (212) 803-8547 anthony.carrini@sourcemedia.com EXECUTIVE DIREC TOR, PRINT & DIGITAL MANUFACTURING & DIS TRIBUTION Michael Candemeres GROUP PRODUC TION DIREC TOR Christine Spataro PRODUC TION MANAGER Maria Marcoff CEN TRAL SALES CO-MANAGER Karen Calderone (303) 504-9054 karen.calderone@sourcemedia.com CEN TRAL SALES CO-MANAGER Carrie Dry (630) 810-0343 carrie.dry@sourcemedia.com EASTERN SALES MANAGER Anita Lande (847) 722-6482 anita.lande@sourcemedia.com CLASSIFIEDS SALES JoAnne Kao (212) 803-8325 joanne.kao@sourcemedia.com HEALTH CARE GROUP Senior Vice President/Group Publisher Jim Callan james.callan@sourcemedia.com

REPRINTS/WEB RIGHTS MANAGER Denise Petratos (212) 803-6557 denise.petratos@sourcemedia.com ASSOCIATE DIREC TOR, AUDIENCE DEVELOPMENT, CIRCULATION Matthew Bramble EVP & MANAGING DIRECTOR INVES TMENT ADVISOR AND PROFESSIONAL SERVICES GROUPS Bruce Morris (212) 803-8808 bruce.morris@sourcemedia.com

EDITORIAL ADVISORY GROUP Phyllis Schuck, CIO, Pinehurst Surgical Group; Chuck Christian, CIO, Good Samaritan Hospital; Denni McColm, CIO, Citizens Memorial Healthcare; Charles Jaffe, M.D., CEO, Health Level Seven; Chuck Mc Devitt, CIO, Self Regional Healthcare; John Bosco, CIO, North Shore-LIJ Health System

Greg Gillespie

Editor-in-Chief

CEO Douglas J. Manoni CFO Rebecca Knoop EVP, & MANAGING DIRECTOR, BANKING & CAPITAL MARKETS Karl Elken EVP & MANAGING DIRECTOR, PROFESSIONAL SERVICES GROUP Bruce Morris EVP, CHIEF CONTENT OFFICER David Longobardi EVP, MARKETING SERVICES Adam Reinebach SVP, CONFERENCES John DelMauro SVP, HUMAN RESOURCES AND OFFICE MANAGEMENT Ying Wong VP, FINANCE Jamie Brokowsky