EHRs and Coding

While EHRs are hypothesized to provide many benefits, concerns have also been expressed about a less positive potential use–that they might facilitate documenting greater patient sickness and comorbidity levels, resulting in higher reimbursements from Medicare and other payers.  A study in Health Affairs, using American Hospital Association survey data and information from various CMS databases, attempts to discern whether recent adoption of EHRs by hospitals is linked to higher reports of patient acuity and reimbursement, compared to a control group without such adoption.  (HA Article)  Almost all hospitals have some form of electronic medical and other records, so the researchers focussed on whether at least one clinical unit in the hospital had adopted all ten functions in one widely accepted definition of having implemented an EHR, and also focussed on specific adoption of computerized physician order entry and clinical notes, which may have a stronger effect on coding practices.  Hospitals defined as EHR “adopters” were matched with control hospitals that did not meet the EHR adoption criteria.

Over 390 hospitals fell into the adopter category and were compared with 782 control hospitals.  No significant difference in patient acuity was found between the two groups.  Similarly, there were no significant differences in Medicare reimbursement, although the control group did have higher growth in payments, contrary to the underlying hypothesis.  The same was true for the specific analysis of the CPOE and clinical notes functions.  And for-profit hospitals, hospitals in competitive markets and hospitals with the highest percent of Medicare patients also showed no different acuity or reimbursement impact from adoption of an EHR.    Some obvious limits to the study include the self-reported nature of EHR use and the widespread use by hospitals by a variety of tools and vendors who help them maximize reimbursement, which may mask the comparative effect of using an EHR for this purpose by the “adopter” hospitals.  While the article gives a degree of comfort, vigilance is still warranted on the potential for EHRs to be used for revenue maximization.