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Rise of EHRs in hospitals hasn’t led to more upcoding: Study

Healthcare’s slow and still incomplete transition to electronic health records has been frustrating to watch for many long-time observers. I for one remember covering electronic data interchange back in 1996 in my first job as a healthcare journalist, writing a publication called Physician’s Payment Update. One of my first articles discussed how submitting electronic claims was reducing payment delays for some practices and easing some administrative burdens. And that was years before anything we’d now consider a smartphone.

It seemed only natural that if claims were being submitted electronically, then electronic medical records would be the next step. But, eighteen years later, we’re still not totally there, and considerable skepticism remains in some quarters about the value of the whole enterprise.

One concern in particular has been that increased adoption of electronic health records could result in a corresponding increase in billing fraud, particularly in the form of upcoding. Frankly, I’ve never understood this concern – there’s nothing magically more pure about paper records, after all – and have generally written it off as part of the lingering Luddism of some old hands who remain in deep denial of the fact that the future of pretty much everything is digital.

Still, it’s always nice to find good data to support one’s beliefs. In this case, the good data comes in the form of a study published last week in Health Affairs that compared billing records from hospitals that use EHRs with the billing records of similar hospitals that still use paper.

The result? “[W]e found no empirical evidence to suggest that hospitals are systematically using EHRs to increase reimbursement,” according to the study’s abstract. “Our findings should reduce concern that EHR adoption by itself will increase the costs of hospital care.”

Well, yes, they should. But one study isn’t likely to shut down the debate about this. I only hope the powers that be heed the advice of the researchers, as related in this release from the University of Michigan News Service: “The authors recommend that policymakers focus on ensuring that hospitals use EHRs in ways that are most likely to reduce health care spending and improve the quality of care.”

Makes sense to me.