U.S. House and Senate committee leaders in recent weeks have been questioning the value of the electronic health records meaningful use program and whether EHRs are being used to bill for services at higher rates. Some Health Data Management readers aren’t particularly impressed with the lawmakers. Here are their comments:

* “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 advantage to us as we will never get more than our rate for each visit. I think the members of the House are unclear on both the complexity 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 charting has likely resulted in down-coding because of the complexity of documenting all required aspects of the encounter and the accompanying 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 appropriate to the work done. If the powers that be start throwing impediments 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 document 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 records 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 identified 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.”

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