At the Intersection of Health, Health Care and Policy Cite this article as: Julia Adler-Milstein and Ashish K. Jha Electronic Health Records: The Authors Reply Health Affairs, 33, no.10 (2014):1877 doi: 10.1377/hlthaff.2014.0917
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
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doi:
10.1377/hlthaff.2014.0917
Electronic Health Records: The Authors Reply We are grateful for Donald Simborg’s letter and agree wholly that “it is quite possible that some hospitals are using EHRs to fraudulently increase Medicare reimbursements.” Our study went further, asking not whether there are a few bad apples (there undoubtedly are), but whether the phenomenon of upcoding inpatient care after the adoption of an electronic health record (EHR) is widespread. We found no evidence that it is. We appreciate Simborg’s point that EHR-driven upcoding may still be happening in ambulatory care. Our study focused on inpatient care for a simple reason: Hospital care accounts for the largest portion of US health care spending. Indeed, it was hospitals that were targeted by the Department of Health and Human Services for potential EHR fraud. The underlying phenomena described by Simborg and others— record cloning and single-click autopopulating templates—exist in hospital EHRs. If these resulted in coding more complex diagnosis-related groups, the financial implications would far outweigh any upcoding of
evaluation and management Current Procedural Terminology codes that occurs in emergency departments or elsewhere. Since we found no evidence of EHR-driven upcoding in the inpatient setting, it may now be reasonable to examine whether this upcoding is happening in other clinical settings. Finally, our article and Simborg’s letter reflect the shared principle that limited government resources need to be thoughtfully spent. We support Simborg’s efforts to include fraud management solutions in EHRs. This is probably a resource-efficient way to identify those few bad apples. However, the real payoff for the American public will likely come from directing our efforts toward understanding how to use EHRs to improve the quality and efficiency of US health care. Fraud may be a problem, but it pales in comparison to the amount of inefficiency and waste that plagues our health care system. Julia Adler-Milstein University of Michigan ANN ARBOR , MICHIGAN Ashish K. Jha Harvard School of Public Health BOSTON , MASSACHUSETTS
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The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/33/10/1877.2.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2014 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on April 21, 2015 at UNIVERSITY OF BIRMINGHAM
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
doi:
10.1377/hlthaff.2014.0917
Electronic Health Records: The Authors Reply We are grateful for Donald Simborg’s letter and agree wholly that “it is quite possible that some hospitals are using EHRs to fraudulently increase Medicare reimbursements.” Our study went further, asking not whether there are a few bad apples (there undoubtedly are), but whether the phenomenon of upcoding inpatient care after the adoption of an electronic health record (EHR) is widespread. We found no evidence that it is. We appreciate Simborg’s point that EHR-driven upcoding may still be happening in ambulatory care. Our study focused on inpatient care for a simple reason: Hospital care accounts for the largest portion of US health care spending. Indeed, it was hospitals that were targeted by the Department of Health and Human Services for potential EHR fraud. The underlying phenomena described by Simborg and others— record cloning and single-click autopopulating templates—exist in hospital EHRs. If these resulted in coding more complex diagnosis-related groups, the financial implications would far outweigh any upcoding of
evaluation and management Current Procedural Terminology codes that occurs in emergency departments or elsewhere. Since we found no evidence of EHR-driven upcoding in the inpatient setting, it may now be reasonable to examine whether this upcoding is happening in other clinical settings. Finally, our article and Simborg’s letter reflect the shared principle that limited government resources need to be thoughtfully spent. We support Simborg’s efforts to include fraud management solutions in EHRs. This is probably a resource-efficient way to identify those few bad apples. However, the real payoff for the American public will likely come from directing our efforts toward understanding how to use EHRs to improve the quality and efficiency of US health care. Fraud may be a problem, but it pales in comparison to the amount of inefficiency and waste that plagues our health care system. Julia Adler-Milstein University of Michigan ANN ARBOR , MICHIGAN Ashish K. Jha Harvard School of Public Health BOSTON , MASSACHUSETTS
Octo ber 201 4
33:1 0
Downloaded from content.healthaffairs.org by Health Affairs on April 21, 2015 at UNIVERSITY OF BIRMINGHAM
H ea lt h A f fai r s
18 77
