Home Forums Discussions General Discussion Guess what EMRs are doing.....

Hi everyone,

http://www.nytimes.com/2012/09/22/b...pitals-with-electronic-records.html?_r=1

Just as our cash flow is improving from a much higher percentage of 99214s.

So the feds next step will be.....

Gene

Gene,

If it bleeds it reads. Once again a rather intentional, uneducated, shallow and simplistic view of the subject matter at hand.
The lumping of all EHR using physicians into fraudulent overcharging greedy lowlifes is a bit disturbing.
However, I am not surprised of the increase in medicare reimbursements.
On a microcosmic level, since converting last November, I have been giving more of the standard vaccines (because of the reminders), utilizing the 25 modifier when doing the annual wellness with a 99213 because it is what I am doing and for years have been underbilling without realizing this.
I am now scrubbing my own superbills, so the gals out front have much cleaner superbills to submit, and a cleaner posting process because of the quick codes section.
Uncle Sam can blame himself for finally re-imbursing us now for the annual exam on medicare patients! The medicare patients do not have any out of pocket expenditure for the wellness portion. I make darn sure I bill the annual wellness and have all the necessary requirements such as the wellness assessment form, vision screening, end of life issues discussion, list of other providers etc....
I have had a few private pay patients complain with the annual or 99213 not being covered when using a modifier, but have educated them on my rational for the charge, and most understand.
I suspect the heavily templated bulky EHRs the REC's (Regional Extension Centers) are pushing docs towards are the EHR's that the hospital administrators love and the physicsians hate. Next Gen comes to mind on the recent Medscape Survey Leslie brought up recently.
However, there may be more of a tendency to upcode and put data into a note that was not actually done if you are using one of these heavily templated EHRs, and asked by your employer (the hospital) to see 25-30 patients a day because their in patient monies are drying up on the vine with the bundling of services, and now the hospital is depending more on the outpatient services to supplement income.
But to insinuate all EHR utilizing docs, as Dr Simborg implies in the last sentence of the article, is maddening at the least.

The next Times article will be about the crisis in primary care coming because PCPs aren't being fairly paid! Our national press are nothing if not schizophrenic.

Schizophrenic is too kind of a description

It will be interesting to see them look read through the 10 page ER nonsense documentation in bulk to conclude that it was cloned. Even more difficult to prove that the work was NOT done.

This article is wrong in so many ways; it is hard to know where to begin to criticize it. For one:
Payers (private and governmental) have maintained that EMR's will improve the quality of care. Hence the significant financial incentives to adopt them.
The same payers have insisted that we need to get away from volume-based payments and "pay for quality not quantity".
So we took the difficult and expensive steps they said would improve quality...and now they are surprised that the payments are higher? This is not the result of some manipulation of the system; it is a totally predictable result.

I for one, thought this was evident the instant EHR's became available, shortly after the reimbursement system of requiring "bullet points" to establish payment came into being. Once reimbursement became tied to the amount written as opposed to the quality, doctors, being bright folks, adapted quickly. Third party payers view payment as a "zero sum game"; so, naturally, the payment for services in general was reduced as more higher charges were received.

Reality is that each of us should be able to look at what we do, smear the complexity along a ruler, and divide it into real relative value chunks. The elderly man with multiple problems whom we are keeping strapped together with medical duct tape and who requires weekly visits to avoid disaster should be a 99215 every time, even if his family history is irrelevant. The woman who just never got the word that we have nothing to offer for a head cold should be a 99212. What we deserve is a system that pays fairly for an honest billing, not a computer game.

At least in primary care, the only way that doctors can be paid properly would be to revert to what I think is the old indemnity model. The patient pays your fee, whatever it is, and gets reimbursed by the insurance company for the amount they want to pay for that type of visit. Then, patients can actually compare prices for "kind of similar visits" and there might be something identifiable as an FMV for some the medical service.

If only you could do that with Medicaid.