Posted on 02/21/2018 12:43:37 PM PST by spintreebob
Electronic health records were supposed to lower administrative costs, but they may not be getting the job done, according to a new study published this week in JAMA.
Administrative costs made up as much as a quarter of professional revenue for some patient encounters, according to the study, which focused on a single academic medical center. Researchers attribute much of the high cost to varying contracts between the hospital and health plans and payer as well as varying price schedules.
"After investing more than $30 billion in health IT, we haven't improved the administrative efficiency," said Dr. Kevin Schulman, one of the study authors and the associate director of the Duke Clinical Research Institute. "That was one of the big promises of digitizing records."
For the study, researchers estimated the time each billing step took for a 1,500-bed academic healthcare system in North Carolina. Based on the calculated time and salary information, they estimated personnel costs and also added in overhead costs.
As visit complexity increased, so did the time and costs associated with billing and insurance activities. The estimated total time to process a bill for the least expensive type of encounter, a primary-care visit, was 13 minutes, at a cost of $20.49. The average time for the most expensive type of visit, an inpatient surgical procedure, was 100 minutes, at a cost of $215.10.
Costs associated with billing were even higher when researchers took the cost of the EHR software into account, rising to $32.52 for a primary-care visit and $319.80 for an inpatient surgical procedure.
Across the types of patient encounters, billing costs made up between 3.1% (inpatient surgery) and 25.2% (emergency department visit) of professional revenue.
"These findings suggest that significant investments in certified health information technology have not reduced high billing costs in the United States," the researchers wrote.
The researchers could not attribute the high costs to "any significantly wasteful or inefficient efforts" in billing, something they speculate could be due to the fact that the health system uses a single billing organization.
Instead, they attribute the costs to differing contracts with payers and price schedules that remain unstandardized.
"We think the costs are due to the complexity of the market itself," Schulman said. "Part of that complexity comes from the fact that every insurance company has their own way of doing things," he said. "This is a cost that's passed onto the provider organizations."
Any time there's complexity associated with a system, there are costs associated too, said John Kelly, principal business adviser for software firm Edifecs.
"Payers and providers haven't really agreed to exchange a lot of information," he said. "By automating the exchange of information, you can make that complexity easy."
But the EHR alone won't solve everything.
"Adoption of certified EHR systems by hospitals appears to have been unable to cope with the complexity of multiple payer contracts," the study authors wrote.
Nor has it brought about great change in administrative processes.
"We hope this will be a wake-up call that it's time to focus on administrative simplification," Schulman said.
"Time to focus on administrative simplification" Two ways to do that: 1) Remove ACA and other government regulations. Let patients, insurers, medical professionals figure it out in the market place. 2) Impost one-size-fits-all from the central bureaucrats to everyone. Once-size-fits-all is certainly a simplification.
EHR has nothing to do with with saving costs and everything to do with tracking
Yes, I am sure this is another thing about which 0bama lied to us. He insisted that billions of health care costs could be saved by using EHRs, but it was always my feeling that the real goal was government access to all of our medical records and/or a plan to create dependency by medical providers on government for record-keeping.
I thought they were called EMRs now?
I like the way you think.
The true purpose of the EHR project is just beginning to come into focus.
Ask yourself this: Why would a corporation or a “charity” invest tens of millions of dollars to REPLACE a fully-evolved, purpose-built record system with something completely different without understanding the ROI?
After all the blather about “population health” and “continuous quality improvement”, “patient engagement” and “clinical decision support”, you really have to ask, “where’s the return on our investment?”
Answer that, and you will understand what the EHR is all about.
As someone who manages an EHR, I suspect this is true.
However, the purpose of an EHR is not to bring efficiency, accuracy, or improve patient care.
The purpose of an EHR is to generate the reports required for compliance with the regulatory requirements of multiple government agencies and insurance companies.
I don’t disagree with the findings. I will say that in my life I have found ready access to labs, MRI and CT Scans and other items to be a godsend. They save time and have spared a couple of misdiagnoses.
Of course, I’d you are not tied into the system, it sucks. A lot.
This is not PRINCIPALLY about meeting regulations.
It’s principally about collecting more money for the same service. Which is easy to do with a 2nd or third-generation EHR.
This is the same as word processors didn't speed the time to delivering a final document. It increased the number of revisions and corrections that take place.
Given the way that JAMA has blatantly lied to us about guns in the past, I’m disinclined to believe anything these liberal swine tell us.
My docs have had to hire medical scribes to do their hunting and pecking for them. How is hiring another layer of admin supposed to lower costs??
AMEN! As a person who ran and owned a company dealing with computerization of doctor's offices, I can testify long and hard about this.
Fortunately I got out in late 1999, about the time HIPPA and electronic insurance claims were making the doctor's office a nightmare.
The dirty little secret is that the majority of attending physicians in the hospital are inept using EMR. Clinical notes are cut and paste fictions. Orders are not written. Physicians spend more time at the computer than they do at the bedside. Patient care has suffered and will continue to suffer for a generation.
And bad handwriting.
However, the purpose of an EHR is not to bring efficiency, accuracy, or improve patient care.
The purpose of an EHR is to generate the reports required for compliance with the regulatory requirements of multiple government agencies and insurance companies.
Bingo. The patient is no longer the customer. The government is the customer. The patient is just a widget in the process.
The customer is always right.
The estimated total time to process a bill for the least expensive type of encounter, a primary-care visit, was 13 minutes, at a cost of $20.49. The average time for the most expensive type of visit, an inpatient surgical procedure, was 100 minutes, at a cost of $215.10. ahem... BULLSH!T!!!
Billing of course. Providers have to bill under increasingly complex and discrete codes.
I notice my pcp group’s EMR permits them to churn accounts constantly for me and their other patients to come in for “covered services” and regularly scheduled screenings.
Any other ideas, Jim Noble.
I notice we are in the same Freeper class, 98.
“How is hiring another layer of admin supposed to lower costs??!”
It’s not.
DUH.
Why would anyone think EHR systems which primary purpose was to generate a bill, And yes folks that’s what their primary purpose was, was going to reduce billings???
It’s purpose was to make sure you got billed as much as possible for every little thing.
Everything else they do were added assecondary functions to support that goal.
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