Oh, the Games We Play

Remember how great EMRs were in helping you code better?  Well, now the government believes hospitals are using the EMR as a tool to “inflate payments or to exaggerate the intensity of treatments in order to reap profits from Medicare.”  Now this should scare you.  First of all, our coding system is a joke.  An ear infection could be a level three or four depending on how much you document.    You can game the system, which is wrong.  That being said, many systems are on self-pilot and basically code for us.  I am using one now.  That has got the government pissed.   Attorney General Eric Holder and US Health and Human Services Secretary Kathleen Sebelius have sent letters out to chief executives of five groups stating,  “We will not tolerate health care fraud.  Law enforcement will take appropriate steps to pursue healthcare providers who misuse electronic health records to bill for services never provided”.    What?  They are making this a criminal case?   Read the original NY Times article here.    What amazes me is that the coding system was created by the government but when it is used to its fullest by doctors it puts them at risk of going to jail.  Are you kidding me?

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “Oh, the Games We Play

  1. John P. Stewart
    October 1, 2012 at 8:56 am

    All this EMR/coding/billing/marketing/medicine is a business not a profession stuff was a big factor in my retiring early. If I had wanted an MBA I would have got one.

  2. John P. Stewart
    October 1, 2012 at 8:50 am

    All this EMR/coding/billing/business not clinical medicine bull#$%^ is a main reason I retired early. If I had wanted an MBA I would have got one.

  3. Bridget Reidy
    September 30, 2012 at 11:14 am

    I hope they crack down by paying for billing auditors sophisticated enough to know when a complete review of systems or 8 item physical is indicated, and what useful information should be in an assesment or HPI. Maybe then we could actually read each others records again for the purpose of understanding what happened at the visit, the original purpose to keeping a record to begin with. But that wouldn’t work because we’d all go broke. Or maybe they’ll scrap the whole rediculous E and M codes, since they are too laughably complex to explain to patient watch dogs, in favor of the hard to abuse and fairer payment by the minute – and then we wouldn’t have to do stupid medically unnecessary stuff just to get paid for taking the time to get the right information or all the unreimbursed medically necessary services. it really is silly when you think about it. The wrong med list or a bad HPI from a difficult patient can lead to a wrong diagnosis, while the frequent case of the primary care patient who needs two of his chronic problems, one or two acute problems, and at least one prevention issue dealt with at one visit pays the same as an acute visit for a URI. Maybe a coding system with input from people who provide ongoing primary care would fix the fraud problem as well as the comprehensive primary care shortage and the emphasis on acute care in America today.

  4. September 28, 2012 at 3:04 am

    With a team like that, it’s no wonder Obama blew a once-in-a-generation chance at strengthening the financial system.

  5. September 26, 2012 at 5:11 pm

    Ah, so.

    What this really means is that I won’t be able to dispose of the paper backing up my practitioners’ electronic records. That is, the paper demonstrating that they actually did do the exams and the previous visit wasn’t just pulled forward and modified here and there.

    Love it. Electronic medical records that have to be backed up by paper.

  6. September 26, 2012 at 11:02 am

    I have read in many places, and heard at conferences, that a high percentage of physician billing has been under-coded for fear of being audited. But now, with EMRs, we are coding more correctly, and being reimbursed more properly.
    Ahhh, the Law of Unintended Consequences strikes again!

  7. September 25, 2012 at 11:16 am

    Of course it’s being criminalized! There was a case somewhere out west (CA?) some years back when large insurance company was sued for disallowing too many Level 4 visits by a physician group, even though properly documented. Think about it: for years residents were trained to think in terms of coding optimally, which is by definition gaming the system! Now billing for too much work, doing exactly as they were trained, is mischaracterized as fraud. So charge all you want, but don’t be too far outside of the norm. This is another layer of ThoughtCrime as crowd control. And all the “single payer” advocates who read this site would be wrong to read this as hysteria. This is furthering exactly what they unwittingly have sought.

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