The key metric to qualify physician and hospital providers for the incentive payments issued by the federal government in the ARRA is meaningful use. What constitutes meaningful use? Ultimately, who can evaluate each EMR for this seemingly elusive quality? Could it be easier, in fact, to identify what doesn’t qualify as meaningful?
Insurance companies, especially those who follow Medicare’s guidelines, require an increased level of proof that services were rendered to their policyholders. If sufficient proof is not provided these companies can and will deny payment and in some instances request payment back if those services were paid for previously. With the amount of fraud and abuse that has been documented through the years by physician and hospital providers alike, it is understandable that insurance companies are determined to ensure to only pay for services that were truly rendered.
Cancer treatments for example, with its expensive pharmaceuticals and radiation therapy, totaled $28.8 billion out of the 337 billion spent in Medicare payments in 2006. For more information this site contains interesting information on the cost of cancer treatment in the aging: http://www.allhealth.org/briefingmaterials/CancerandMedicareChartbookFinalfulldocumentMarch11-1412.pdf Chemotherapy services include a charge for the medications as well as a charge to administer them. If, when called upon, a provider cannot prove that these services were rendered, the patient’s insurance company will deny those services. Meaningful use now comes to the fore front.
Imagine this scenario. Documentation requests are received by a hospital system. Actual clinical cases where the documentation and payments are being called into question were presented. The reporting piece of the EMR software in place at this hospital system was parsed. Sadly the data extracted was not “meaningful”. The pharmaceuticals could be validated as administered but the means in which they were administered were unclear via the reporting. Even though the medications could be validated as administered the insurer will deny the entire payment resulting in a loss for that visit. How often can a provider endure this scenario before he can no longer afford to practice medicine? If clinicians are to utilize or chart in an electronic medical record then certainly there should be a means to extract the data so anyone reading its reports can validate the services.
Clinicians have been asked to migrate from paper charting. They have been trained before the introduction of EMR that not documented is not done. In the not too distant past, it was fairly straightforward to request and obtain a paper chart and then submit copies to insurance companies requesting information. How can one satisfy these documentation requests now? Is there a means to validate that an EMR system will be user friendly and allow data to be mined in a “meaningful” way, that will protect the provider and not expose him/her to risk?