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.