An articleby Lisa Wangsness in the April 13, 2009 issue of the Boston Globe shows that the time has come to reveal an era of misdeeds by the healthcare community (i.e. doctors and hospitals).
The misdeeds are partly revealed by a seemingly innocent attempt by Google to import medical billing data into their electronic health records (EHR) database.
In this case, a cancer patient, Dave deBronkart, transferred his medical records from Beth Israel Deaconess Medical Center to Google Health. He then found out that the medical codes entered by the hospital for insurance purposes decoded to a list of conditions that he did not really have. So much for accurate health records!
The article in the Boston Globe does not, however, point out that there is deliberate miscoding of health conditions going on. Rather, it describes how the real conditions that deBronkart had were fitted to the codes that seemed closest to them in the coding manual. An exercise of trying to put round pegs into a square hole.
The elephant in the closet, however, is the fact that it is common practice in the United States for physicians and hospitals to deliberately miscode claims to assure that they will get the highest reimbursement and the fewest questions from insurers. This alone should disqualify claims data from entry into any personal health record or EHR. The practice should simply be banned!
This incident should also be seen as a warning to consumers that using EHR systems like those from Google or Microsoft does not come without risk. These are large companies that think they are doing good while growing their business. In this case they are exhibiting poor judgment and no viable method for fixing the problem.
Hospital systems, like Beth Israel Deaconess, that provide the data for transfer to EHR systems like those at Google and Microsoft deserve even greater blame for allowing claims data to be transferred in this manner. Unlike Google and Microsoft, it should be obvious to them that these data are simply inappropriate for such use.
As to the deliberate miscoding of medical conditions, it is time to recognize that this common practice is simply wrong. It is fraud, pure and simple. Yes, there will be lawsuits and public outrage. Penalties will be paid by the hospital systems without admitting guilt. Fortunately, we will have a somewhat better healthcare system when we emerge on the other side.