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What could replace E&M coding to improve healthcare (and EMR)?

Posted on January 21, 2011 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A comment on my somewhat controversial thought post about imagining an EMR without billing reminded me that I wanted to ask the question of my readers about what could replace E&M coding. Seriously, I can’t think of anyone I know that actually likes E&M coding. I know some people that are good at it and so they like that they have a skill in that area. However, I don’t remember anyone being a proponent of E&M coding because it provides better patient care or makes life easier for doctors. Am I just missing these reports? So, this leads to the important question…

What could replace E&M coding that would improve healthcare and still handle billing?

Plus, after you read the comment below, you’ll understand why improving billing could also improve many of the billing machines EMR software that’s out there as well. Let’s hear your thoughts.

Here’s the comment that prompted this thought:

The broader problem is that the billing aspects have many more insidiously negative effects than simply sending a charge transaction across an interface.

They actually degrade the quality of the documentation by requiring certain elements to support specific levels of billing. The whole issue of needing to have a certain number of elements done and documented to bill a particular E&M code is one example. A particular visit may have extremely complex history/assessment/decision-making but to get “credit” one also has to document a certain number of irrelevant review of systems items.

It is no surprise that the places that have used EHRs most effectively such as Kaiser and the VA are incentivized to give care that will produce better outcomes. They are less beholden to bureaucratic insurer-driven documentation demands that do not aid in patient care or communication.

Eliminating all of these items (and similar demands for information to fulfill PQRI and other measures that are irrelevant to a particular patient or that fragment thought processes) would improve workflow and efficiency in any system, paper or electronic. It would certainly make it easier to develop an EMR that would support patient care needs.

But just having distinct EMR and billing software isn’t going to do the trick in our current dysfunctional health care system. It is only if an EMR can be designed (and insurer/payor/regulatory demands can be synchronized) so that the health care system looks like a single payer system to the EHR user and clinicians can go about the business of treating patients.

It’s a little bit pie in the sky thinking, but sometimes that’s beneficial.

EMR Billing Matters

Posted on August 25, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

My previous post about imagining an EMR that didn’t include billing certainly has driven a lot of conversation. Actually, that was the purpose of the post. I indulge in great conversation with multiple perspectives. It’s the beauty of blogging and of life.

However, please don’t let that post confuse you. Billing is an absolute essential part of an EMR software. There’s a very good reason why most EMR software out there amounts to little more than a big billing machine. The demand for healthcare software was initially to solve the challenges associated with medical billing. Markets are great at satisfying demands and that’s why the EMR software is the way it is today.

This means that EMR vendors CANNOT ignore billing. Rightfully so, doctors want to get paid for their work.

Of course, the point of the previous post was to try and expand the conversation beyond billing. Basically, the goal was to try and imagine an EMR software world where patient care was the focus instead of billing. What kind of good could we accomplish if this was our goal?

This follow up post was prompted by this somewhat disturbing email I received:
“I have built just such an EMR product for the iPhone and iPad. I am struggling with financing it because everybody wants billing. They really don’t care about the quality of the EMR.”

I’d make one qualification. No one cares about the quality of the EMR, if you don’t satisfy their billing needs too. Reminds me of HIPAA. No one would purchase an EMR that didn’t meet the HIPAA standards. However, once they hear it meets those standards, they move on to other things like the quality of the EMR.

Doctors and Patients and Paperwork

Posted on April 23, 2010 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was reading through a thread over on EMR Update which talks about this New York Times article. Here’s some really interesting quotes from both sources that are worth considering:

In “The Hostile Hospital,” from the Lemony Snicket “Series of Unfortunate Events” books, the three young orphans at the center of the story visit the fictitious Heimlich Hospital, where Babs, the head of human resources, asks them if they know what the most important work done in a hospital is.

“Healing sick people?” one of the children asks innocently.

“You’re wrong,” Babs growls, silencing the children. “The most important thing we do at the hospital,” she continues without flinching, “is paperwork.”

Humor is the most funny when it stabs so close to the truth.

Currently, most systems have been designed not with clinical needs in mind but to meet the demands of the fee-for-service payment system. The software rapidly codifies diagnoses and symptoms, thus facilitating billing.

No worries though. The EMR billing machines that we have now will soon be replaced with EMR meaningful use machines. {a little satire of my own}

While EMR can capture certain information like medication lists and test results with mind-boggling accuracy and efficiency, it often fails to relay the nuances of a patient’s illness course. “Physicians think in stories,” said Dr. C. T. Lin, a practicing internist and chief medical information officer for the University of Colorado Hospital in Denver, which has used electronic records since 1994. “How can you possibly point and click your way through a patient’s 10-year history?”

This reminds me of the rather compelling video I did with Mmodal where they talk about the need to have both the narrative and granular data in the EMR. I’m always amazed at a physicians ability to look at a narrative section and get the story of what’s happened. Something that lists and results just can’t do justice. As valuable as those lists and results can be in other ways.