An Example Where an EHR Overcharges Healthcare

Posted on September 5, 2014 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.

In response to my post “Study Says Overcharging by the Hospital Might Be Overstated“, Patrick Duffy from PDA Consulting offered these added insights into the “overcharging” that exists in healthcare.

Some are overcharging thanks to EMR upgrade coding errors. How about $720 for ONE nitro tablet. Insurance company did not catch it either. About 9 months after an EPIC implementation so how many people/Insurance were overcharged and never knew?

In the meantime a gastric band operation in the UK is $7500 average. In the US it is between $15k and $30k depending on State. Is that not overcharging?

I’d never heard of an EHR software doing this, but it’s not surprising at all. In fact, it’s probably not even happening because an organization is trying to be dishonest. When you look at the complexity of an EHR implementation, it’s not surprising at all that things like this happen.

It’s also not surprising that the insurance company hasn’t caught it…yet. Notice how I added in the yet there. We’ll see if this comes back to bite healthcare organizations. Insurance companies do get behind on a lot of things, but they do go back and plug holes and then it hurts.

There are so many issues with the way we reimburse healthcare, that I’m honestly not sure where to start in order to fix it. It’s a complex web of overhead.

In the tech world, a software program has technical debt (also known as design debt or code debt). We see it happen across the EHR and health IT software world. Over time, you accrue a debt of issues in your software that make it easier to scrape the old software that’s encumbered by technical debt and rewrite it from scratch so that you can do it the right way.

When I look at the healthcare reimbursement system it’s got a very similar problem. There’s a healthcare reimbursement design debt that’s grown so large that there are no easy fixes to the system. I guess that’s why I asked the question, “Is Healthcare So Complex That It Can’t Be Fixed with the Existing Parts?