Hospitals Using EHRs Not Any More Likely to Overbill, Says Study

A new study contradicts a prevailing notion that hospitals use their electronic health record system to inflate their reimbursements by selecting more lucrative billing codes.

A 2012 study from the Center for Public Integrity determined U.S. hospitals collectively overbilled Medicare for emergency department procedures that were 'upcoded' in EHRs. This study and several other similar reports caught the attention of HHS and U.S. Attorney General Eric Holder, who responded with a letter to the major hospital and medical associations emphasizing the federal government's commitment to detecting and prosecuting such healthcare fraud.

"[T]here are troubling indications that some providers are using this technology to game the system, possibly to obtain payments to which they are not entitled," according to the letter. "These indications include potential 'cloning' of medical records in order to inflate what providers get paid. There are also reports that some hospitals may be using EHRs to facilitate 'upcoding' of the intensity of care or severity of patients' condition as a means to profit with no commensurate improvement in the quality of care."

However, Julia Adler-Milstein, PhD, an assistant professor at the University of Michigan, didn't believe the use of EHRs was causing hospitals to attempt to maximize revenue in ways they weren't already using. "The chances that electronic records are somehow going to magically make that even more financially lucrative? She just didn't buy it," Ashish Jha, MD, a professor at the Harvard School of Public Health in Boston who worked with Dr. Adler-Milstein on the study, told NPR.

The researchers used a longitudinal study to determine if EHR adoption was associated with a subsequent bump in both the severity and complexity of patient conditions and payments from Medicare. Using information from the American Hospital Association's annual survey to both track EHR adoption and ensure control hospitals were comparable in size and population served, researchers analyzed CMS billing data for 393 hospitals that had recently installed a high-functioning EHR and 782 paper record-using controls. The researchers also controlled for productivity changes due to the new EHR and other factors.

The results of the study showed no significant correlation between EHR adoption and patient acuity or Medicare billing. "To my surprise, we found nothing," Dr. Jha told NPR. "We found that EHRs didn't really change billing practices at all."

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