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 "upcoding" is debatable on that point; the outright fraud-such as claims filed for non-existent 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.