… If there ever was a reason for doctors, other clinicians and patients to oppose the use of Electronic Medical Records forced upon them by by third celebrations, here it is. Assuming this story is accurate, it reflects what I believe will be an increasing trend towards control of the medical profession via computer:
Association of American Physicians and Surgeons (AAPS)August 2008 News
With a 19.7% increase in budget, and a 64-person increase in staff to a total of 1,495, the Office of Inspector General (OIG) is aggressively looking for fraud. The anti-fraud cash cow brings in $20 for $1 spent. To “find” fraud, the government gets creative, elevating ordinary billing disputes to fraud.
“The government overkills. It ruins their life. Physicians lose their career. They overbill Medicare, and it may have been sloppy,” says attorney Patric Hooper. “But rather than pay back $100,000, they owe millions” (MCA 6/30/08).
One Pinellas County, Fla., doctor was hauled off in handcuffs because of an ongoing dispute with UnitedHealth Care over E&M coding. What preceded the indictment was a refusal by the physician to use [healthcare IT] products sold by Ingenix, a United subsidiary. “It’s clear from the documents that United filed the claim in retaliation,” said the physician’s attorney. “I’ve never before came across such a blatant attempt at coercion by a payer public or private” (ibid.).
Note that electronic medical record software, such as Astonishing Charts, could make you liable for false claims, as through unintentional misuse of cut-and-paste functions or templates that automatically fill in blanks (ibid.).
Enforcement is being enhanced through use of anti-fraud “strike forces.” The investigators are often retired policemen, and they do not treat physicians as “white collar” (MCA 6/30/08).
Some recommendations from Medicare Compliance Alert: Guard your NPI. Screen staff carefully, and watch out for “rogue employees” who might be identity thieves. Report business partners to the government; it can protect your own business. Have procedures in place to deal with search warrants. Be sure the information on your Medicare enrollment form is accurate; wrong information from a form filled in 20 years ago could result in a false claim (ibid.).
AAPS advice: consider opting out.
I believe a much more aggressive response is needed from the medical profession, including organized medicine, besides “opting out” of abusive third party payer arrangements.
In a former role of Manager of Medical Programs for a regional transit authority, I’ve seen labor unions that were representing bus drivers and janitors act far more aggressively and wisely in representing their members against management whims than organized medicine represents physicians against payer and government whims.
“Musn’t be too aggressive or appear disgruntled” is one of the reasons I’ve heard from academic colleagues. Doctors must be “gentlemen.”
I ask “why?” The directness and actual aggressiveness of the labor union representatives I saw in action was quite effective in improving the conditions for their members. Interestingly, the union people were aggressive when “in role” yet polite when I came across them in other settings, such as the daily commute to work.
In a similar vein, I’ve heard from numerous circles that it’s ideal to advocate for informatics leadership of Health IT (such as EMR, CPOE etc.) without demonstrating emotion or ‘disgruntledness.’ That raises several questions:
- Are doctors finding themselves marginalized and at the whim of IT managers, payers and other non clinical third celebrations because they’ve been just too angry and aggressive in demanding what was best for medicine and for themselves?
- Has there ever been any disagreement or conflict of such major proportions (and profitability) as healthcare that has been resolved purely through gentleman’s dialog?
- Finally, are there lessons to be learned from these gentlemen who “petitioned for redress of grievances in the most humble of terms”, only to be answered by even worse treatment?
On leadership of Health IT efforts: the Office of the National Coordinator for Health IT (ONC) was established in 2004 to promote electronic health records in the United Says. Regarding ONC, I’ve recently had some conversation with persons instrumental in the evolution of VistA, the Veteran Administration’s EHR, and listened to presentations on VistA at a number of conferences.
It seems VistA is a very different universe from commercial HIT, one of strong collaboration and pride and creativity. This is likely due to its one-of-a-kind and relatively constrained purpose (care of veterans and family) and the non-profit nature of its history. You can get a good sense of this from the new book “Medical Informatics 20/20: Quality and Electronic Health Records through Collaboration, Open Solutions, and Innovation” (Amazon link here) written by key VistA personnel from that perspective. (Note: I use the book for teaching graduate students about the ideal ways to create and implement HIT and am cited in it for my views on social issues in HIT as at my website).
Commercial HIT is, on the other hand, highly corporatized, in the worst 2008 sense of the word. It is a highly competitive (need I state cutthroat) business, highly fragmented, proprietary, and anything but open. Commerical HIT is characterized by many stakeholders with widely varying agendas, forming an often dysfunctional “HIT ecosystem” (link) that largely excludes clinicians from meaningful decision making. The ecosystem is primarily centered on profit. It is an entirely different world than VistA.
It is a world characterized by issues such as these (thanks to Al Borges, MD and Health IT discussion site EMRUpdate.com for some of these links):
- “Oh no! Half of all current EMRs fail!”, from 1/2007 Technology for Physicians (link to PDF)
- “Avoiding EMR meltdown: How to get your money’s worth. About a third of practices that buy electronic medical records systems stop using them within a year. A little homework can help ensure you buy one that’ll work for you.”, from 12/2006 AMNews (link)
- Quote: “The failure rates of EMR implementations are also consistently high at close to 50%”, from Proceedings of the 11th International Symposium on Health Information Management Research – iSHIMR 2006 (link to PDF)
- Quote: “Industry experts estimate that failure rates of Electronic Medical Record (EMR) implementations range from 50–80%.”, from 7/2006 A Commonsense Approach to EMRs (link to PDF)
- Kaiser Permanante HIT Meltdown (link)
and many others.
This raises several questions:
- ONC was founded by our government. Where, exactly, was the government receiving its inputs on HIT pros and cons, drawbacks and challenges? Was it primarily from the pro-HIT optimists and Pollyannas (per my HIT Ecosystem essay) who believe the challenges are primarily technical, lobbyists, and those whose experiences were largely positive in development of non commercial, massive scale HIT (e.g., VA?)
- Was ONC founded on the premise that the commercial HIT ‘ecosystem’ operates like the VA, i.e., a world of collaboration and creativity? Could it be seeing commercial HIT through ‘rose-colored glasses?’
- Is ONC positioned to comprehend the commercial HIT sector and its issues, and in fact produce a candid and realistic “lessons learned” report as being called for in proposed House Energy and Commerce legislation?
These are very important questions. I do not know the answers. However, the decision makers in our government should ensure that they do.
– SS
[Source : Health Care Renewal]
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