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It’s Not All about Electronic Records
By Dr. David Edward Marcinko; MBA, CMP™
[Editor-in-Chief]
Introduction
To understand the medical records revolution that has occurred this decade, put your self for a moment in the position of a third-party payer; ie; a private insurance company, Medicare or Medicaid etc.
For example, you want to know if Dr. Joel Brown MD actually gave the care for which he is submitting a [super] bill or invoice. You want to know if that care was needed. You want to know that the care was given to benefit the patient, rather than to provide financial benefit to the provider beyond the value of the services rendered.
www.BusinessofMedicalPractice.com
Of Doubts and Uncertainty
Can you send one of your employees to follow Dr. Brown around on his or her office hours and hospital visits? Of course not! You cannot see what actually happened in Dr. Brown’s office that day or why Dr. Black ordered a PET scan on the patient at the imaging center. What you can do however, is review the medical record that underlies the bill for services rendered from Dr. Blue. Most of all, you can require the doctor to certify that the care was actually rendered and was indicated. You can punish Dr. White severely if an element of a referral of a patient to another health care provider was to obtain a benefit in cash or in kind from the health care provider to whom the referral had been made. You can destroy Dr. Rose financially and put him in jail if his medical records do not document the bases for the bills he submitted for payment.
The Payment Paradigm Shift
This nearly complete change in function of the medical record has precious little to do with the quality of patient care. To illustrate this medical records evolution/revolution point, consider only an office visit in which the care was exactly correct, properly indicated and flawlessly delivered, but not recorded in the office chart. As far as the patient was concerned, everything was correct and beneficial to the patient. As far as the third-party payer is concerned, the bill for those services is completely unsupported by required documentation and could be the basis for a False Claims Act [FCA] charge, a Medicare audit, or a criminal indictment. We have left the realm of quality of patient care far behind.
Provider Attitude Adjustments Required
Instead, medical practitioners must adjust their attitudes to the present function of patient records. They must document as required under pain of punishment for failure to do so. That reality is infuriating to many since they still cling to the ideal of providing good quality care to their patients and disdain such requirements as hindrances to reaching that goal. They are also aware of the fact that full documentation can be provided without a reality underlying it. “Fine, you want documentation? I’ll give you documentation!”
Computer Charting and eMRs
Some doctors have given in to the temptation of “cookbook” entries in their charts, canned computer software programs or eMRs listing all the examinations they should have done, all the findings which should be there to justify further treatment. Many have personally seen, for example, hospital chart notes which describe extensive discussion with the patient of risks, alternatives and benefits in obtaining informed consent when the remainder of the record demonstrates the patient’s complaint that the surgeon has never told her what he planned to do; operative reports of procedures done and findings made in detail which, unfortunately, bear no correlation with the surgery which was actually performed.
Assessment
Whether electronic medical records (eMRs) will be helpful regarding fraud prevention, in the future is still not known. But, it is at best naive and more frequently closer to a death wish to think that a practitioner can beat the system, with handwritten notes, computer generated records, or fabricated eMR documentation.
Conclusion
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Filed under: "Doctors Only", Information Technology, Practice Management | Tagged: Business of Medical Practice, david marcinko, EHRs, EMRs, medical charts, medical records, www.BusinessofMedicalPractice.com |
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Top eMRs for 2010
Still, Medscape reports that electronic health record (EHR) systems for medical practices from Greenway Medical Technologies, Epic Systems, and eClinicalWorks continue to be customer favorites, according to an annual ranking of such software, recently released by the research firm KLAS.
http://www.medscape.com/viewarticle/734392
Ann Miller RN MHA
http://www.BusinessofMedicalPractice.com
[Executive-Director]
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AMA Says Claims Errors Cost $17 billion
Claims-processing errors among commercial insurers add about $17 billion in unnecessary administrative costs to the healthcare system annually, according to the American Medical Association, which released its fourth annual National Health Insurer Report Card in conjunction with the group’s annual delegates meeting in Chicago. The 2011 report card is based on a random sampling of about 2.4 million electronic claims for approximately 4 million medical services submitted in February and March 2011 to Aetna, Anthem Blue Cross Blue Shield, Cigna, Health Care Service Corp., Humana, the Regence Group, UnitedHealthcare and, for comparison, Medicare, according to the AMA. The claims were gathered from more than 400 physician practice groups in 80 medical specialties in 42 states.
The average claims-processing error rate for the six commercial insurers that were analyzed in 2010 and in 2011 was 19.3% this year—an increase of 2% over last year, according to an AMA news release. That increase is expected to add $1.5 billion in administrative costs over the course of this year, according to the AMA.
Source: Jessica Zigmond, Modern Healthcare [6/20/11]
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Next Gen MRs?
Imagine being able to analyze all clinical encounters.
IOW: How much shared decision making was really done? What was the connection between the history, the findings, the decisions made, and the evidence used? How much assessment could be achieved by speech analysis and natural language processing, etc?
Although this might seem unrealistic, the research to achieve this goal has already been initiated – call it AV medical records.
http://thehealthcareblog.com/blog/2014/03/13/patientgate-digital-recordings-change-everything/
So, is this the next-gen of audio-visual MRs?
Dr. Boyer
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OIG Reports Fraud Vulnerabilities in Electronic Health Records
A report entitled, “CMS and its Contractors Have Adopted Few Program Integrity Practices to Address Vulnerabilities in EHRs,” highlighting the vulnerabilities associated with electronic health records, which criticized the Centers for Medicare and Medicaid Services (CMS) for its failure to adopt sufficient guidelines to prevent and detect fraud associated with EHRs, was published on January 8, 2014 by the Department of Health and Human Services Office of Inspector General.
This January 2014 Report was not the first publication to discuss potential EHR liability. In fact, it is a companion follow up report to a December 2013 report regarding the use of the “copy-paste” feature by hospitals in their EHR technology, which “could pose a fraud vulnerability.”
Click to access Digitizing_Patient_Records.pdf
Robert James Cimasi MHA AVA CVA CMP™
http://www.HealthCapital.com
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