Worries that hospitals will use EHRs to upcode may be overblown, new study finds

A study appearing in the latest issue of Health Affairs finds no evidence that hospitals are using new electronic health records (EHRs) to increase Medicare reimbursements.

Julia Adler-Milstein, Ph.D., an assistant professor in the School of Information and in the Department of Health Management and Policy, School of Public Health, both at the University of Michigan, in Ann Arbor, along with Ashish K. Jha, M.D., a professor of health policy and management at the Harvard School of Public Health, in Boston, Massachusetts, compared Medicare billing data on hospitals using EHRs with those still using paper records.

Drs. Adler-Milstein and Jha carefully matched the data from the 393 hospitals with electronic records to the data from the 782 hospitals still using paper records to ensure they were comparing hospitals that were the same in terms of size and organizational type, for example teaching hospital or for-profit company.

“To my surprise, we found nothing,” Dr. Jha told Kaiser Health News. “We found that electronic health records didn't really change billing practices at all.”

The possibility that EHRs, which can aid documenting care as easy as clicking a box or pasting in a piece of text, could be used to create a false record of more intensive care than was actually provided, has been on the radar screen for policy makers and healthcare experts for some time. The New York Times published an expose on it nearly two years ago (see Medicare Bills Rise as Records Turn Electronic).

However, hospitals have long focused on maximizing billing through better documentation. The addition of EHRs, while possibly a time saver, may therefore not be creating any new billing opportunities in the inpatient setting. Whether that is true in the outpatient of emergency department (ED) setting remains to be seen. Here, care documentation may traditionally have been more lax and so the addition of abilities to EHRs that simplify documentation may have more of an effect on billing.

Still, according to the study authors, at least on the inpatient side, their finding that in hundreds of hospitals’ claims data there was no empirical evidence of systematic use of EHRs to increase hospital billing through upcoding "should reduce concerns that EHR adoption by itself will increase the costs of hospital care."