NPR logo

What Looks Like Overcharging By Your Hospital Might Not Be

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript
What Looks Like Overcharging By Your Hospital Might Not Be


What Looks Like Overcharging By Your Hospital Might Not Be

  • Download
  • <iframe src="" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript


This is ALL THINGS CONSIDERED from NPR News. I'm Melissa Block.


And I'm Robert Siegel. As more hospitals adopt electronic patient records, there have been concerns that the technology could be used to pad bills and overcharge patients and Medicare. Well, a new study out today says that is not happening. At least one medical software pioneer warns the record still needs scrutiny going forward. Eric Whitney reports on the study and begins with a look at how these records work.

ERIC WHITNEY, BYLINE: In the emergency department at Swedish Medical Center in Denver, Doctor Gretchen Hinson has just seen a couple of patients and is now dictating their information to an assistant.

GRETCHEN HINSON: Go ahead and do 11 for post-concussion syndrome and then prescription for Percocet for discharge.

WHITNEY: This documentation is important so patients get good follow-up care and so the hospital can get paid. The information will get sent to specialists in the billing department who go through doctors notes carefully to make sure they itemize everything their doctors do, and don't miss out on payment. Companies that make medical record software sometimes advertise that their products can help capture more information and, therefore, bring in more money. A couple of years ago, the Center for Public Integrity and the New York Times published stories saying hospitals that had adopted electronic records were sending bigger bills than those using paper. That made sense to Doctor Ashish Jha, a researcher at the Harvard School of Public Health.

ASHISH JHA: When I read those articles, I thought, that's interesting. I'm not surprised to hear that people are using tools to sort of maximize revenue.

WHITNEY: That may not be a bad thing if computers really are just catching things that fell through the cracks before. But Jha was concerned that electronic records might tempt doctors to say they're doing more for patients than they actually are.

JHA: What I worry about - and I've seen this happen - is that there are these templates, and physicians press one button, and then the entire electronic record gets populated with a detailed physical exam.

WHITNEY: This is one example of a feature that's meant to save doctors time but could be abused, allowing doctors to pad their bills with the click of a mouse. After the articles by the New York Times and the Center for Public Integrity ran, the Department of Justice sent hospitals across the country a letter warning them not to over-document. Jha and a colleague at the University of Michigan designed a study to see how much that was happening.

JHA: To my surprise, we found nothing. We found that electronic health records didn't really change billing practices at all.

WHITNEY: The study looked at billing records from hospitals that had adopted electronic medical records and compared them to a group of hospitals that hadn't. They found that those with electronic records did not generate bigger bills than those still on paper. Jha says policymakers should take note.

JHA: This worry about excessive billing - I understand where it comes from, but the empirical evidence says this should not be a big focus of attention.

WHITNEY: Totally the wrong conclusion, says Doctor Donald Simborg.

DONALD SIMBORG: They're looking in the wrong place.

WHITNEY: Simborg started designing electronic medical records back in the 1960s. More recently, the government recruited him to lead a pair of expert panels on how they might be used for fraud. He says Jha's study only looked at patients who stayed in hospitals overnight - not at those in emergency departments or hospitals' outpatient clinics. Those are the places the New York Times and Center for Public Integrity focused on, and Simborg would like to see researchers follow up on that.

SIMBORG: I don't think anybody's done the study that needs to be done.

WHITNEY: While Simborg doesn't think anyone really knows whether electronic records are being used inappropriately in clinics and ER's, he thinks regulators need to spend more energy policing the software industry.

SIMBORG: They can develop the guidelines that would reduce the likelihood that an electronic record would be abused. That's different than threatening them that they're going to be prosecuted if they do these things.

WHITNEY: The study of how hospitals use electronic records to generate bills is in today's edition of the journal "Health Affairs." The American Hospital Association says it proves their members are using their new electronic tools appropriately, but a spokesperson says the association agrees that software companies need to be watched to make sure their tools don't create pitfalls for doctors. For NPR News, I'm Eric Whitney.

SIEGEL: And that story is part of a reporting partnership of NPR and Kaiser Health News.

Copyright © 2014 NPR. All rights reserved. Visit our website terms of use and permissions pages at for further information.

NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.