No link between hospital EHR use and upcoding for higher reimbursement

No association exists between EHR adoption at hospitals and increases in coded patient acuity or Medicare payments, according to a study published in the July issue of Health Affairs.

Researchers from the University of Michigan, Ann Arbor, and the Harvard School of Public Health analyzed data from the American Hospital Association Annual Survey, the IT supplements to the annual survey, Centers for Medicare & Medicaid Services impact files and Medicare Provider Analysis and Review files. They sought to determine whether concerns about hospitals “upcoding,” or submitting billing codes that reflect more intensive care or a sicker population to receive a higher reimbursement, were justified.

“Indeed, the concerns have been so widespread that the secretary of the Department of Health & Human services and the U.S. attorney general publicly warned that hospitals would face substantial legal risks if they systematically used EHRs to upcode their care for Medicare beneficiaries,” wrote authors Julia Adler-Milstein, PhD, assistant professor at the University of Michigan, and Ashisha K. Jha, MD, MPH, professor of health policy and management at the Harvard School of Public Health.

The researchers found that hospitals that adopted EHRs increased billing to Medicare, but at a rate comparable to that of matched controls of non-EHR adopters.

“A policy intervention to reduce fraud is therefore not likely to be a good use of resources. Instead, policymakers should focus on ensuring that hospitals use EHRs in ways that are likely to reduce healthcare spending and improve the quality of care,” concluded the authors.