I was listening to the news driving my son to school today when an anchor began discussing the election and healthcare, and referred to one candidate (who shall remain nameless) who suggested that people are getting all the healthcare they need right now. Having a heart attack? Just go to the ER.
Seems quite a few people are doing just that, replacing cardiologists – and primary care doctors – with the ER. Now no one would tell you to call your doctor if you think you’re having a heart attack. The ER is the right place to go. But many people are using the ER for burns and sprained ankles and all kinds of minor injuries, because they don’t have health insurance, or a doctor to go to.
Use of the top two most expensive codes for emergency room care nationwide nearly doubled, from 25 percent to 45 percent of all claims, during the time period examined, according to a report. And who’s being hit the hardest? While taxpayers paid most of the bill, the charges “also hit elderly patients in the pocketbook, increasing the amount of their 20-percent co-payments for emergency room care,” the report added.
Between 2001 and 2008, hospitals across the country dramatically increased their Medicare billing for emergency room care, adding more than $1 billion to the cost of the program to taxpayers, a Baylor Medical Center investigation has found. The billing codes physicians use to charge for ER visits make payments rise with treatments that require more time and resources.
Are patients sicker now? Are hospitals just billing more accurately? Or are patients who aren’t that sick coming to the ER for routine care?
These are all factors, but the center’s investigation found that the surge in billing also reflects “lax government oversight, confusion about proper billing standards, and widespread payment errors that have plagued Medicare for more than a decade.”
A small portion of the billing increase is likely caused by outright fraud, but in the majority of cases hospitals are legally boosting profits by targeting the vulnerabilities of Medicare’s payment system, said Dr. Donald Berwick, the immediate past administrator of the Centers for Medicare and Medicaid Services (CMS), which administers the Medicare program. “They are learning how to play the game,” Berwick said.
That’s not all Medicare has to contend with now. The move to EHRs may also be contributing to billions of dollars in higher costs for Medicare, private insurers and patients by making it easier for hospitals and physicians to bill more for their services, whether or not they provide additional care, according to a story in The New York Times.
CMS has so far pretty much ignored the spike in hospital billing. 2011 comments published in the Federal Register, in which CMS said it noticed a “slight shift” toward hospital billing of more expensive evaluation and management codes. But the agency said it also noticed that emergency room charges for the higher-level visits do “seem to be trending upward year over year.”
Edited by
Brooke Neuman
