Consumers in Vero Beach and the rest of Florida are currently caught between two powerful groups in a battle that, by law, shouldn’t even be happening. This tooth and nail fracas is largely about medical testing and your health records but, according to Bill Neil, chief information officer at the Indian River Medical Center, you may be able to stay out of the line of fire and still get what you want without getting what you don’t want.
On one side of this fight – claiming that Florida doctors are unscrupulously over-testing older patients to bolster profits – are solidly reputable publications including Consumer Reports and the New York Times along with Medicare, Medicaid, the American Association of Retired People, (AARP) as well as state and federal consumer protection officials. On the other side – arguing that a dysfunctional medical records system explains or even justifies the questionable tests – are equally reputable physicians and medical groups as well as the Wall Street Journal and nation’s premier business magazine, Forbes.
The latest skirmish in this battle started on the last day of 2014 when the New York Times published a report claiming that physicians in the Sunshine State were gouging consumers – and particularly retired winter residents whose fulltime homes and doctors are back up north – with unnecessary and unwarranted medical testing.
No one disputes medical testing can, indeed, be something of a cash cow for unscrupulous physicians; particularly those who treat the elderly. According to the Times, Florida is rife with examples. Just this past November, eleven people were arrested at Coral Gables’ Florida Healthcare Plus and charged with running a $25 million Medicare fraud scheme that included substantial bogus testing charges. Also in November of 2014, the U.S. government joined a lawsuit filed in 2011 against a Vero Beach doctor claiming the physician had billed Medicare for procedures that were either not performed at all or were medically unnecessary.
The Times further claimed its analysis of Medicare data showed Florida heart doctors ordered more than double the number of nuclear stress tests, cardiac ultrasound tests and echocardiograms than doctors in other states. In many of those cases, the paper claims, the vacationing patient’s hometown doctors were completely unaware those tests were being ordered. The Times says a similar pattern prevails in other Sunbelt states – Arizona, California, southern Nevada and South Texas – that are popular winter destinations for retirees.
Consumer Reports chimed-in saying it found 44 percent of people with no signs or symptoms of heart disease had EKGs, exercise stress tests or ultrasounds ordered and concluded such testing “is more common than it needs to be.”
In response, Dr. A. Allen Seals, the president of the Florida chapter of the American College of Cardiology quickly refuted the Times’ allegations about Florida heart doctors. Less than an hour after the Times’ article was published, Seals issued a statement saying; “I see patients on a regular basis walk into our practice without their medical records from their northern homes.” Seals’ point being that with no medical records to go on, Florida heart doctors have no choice but to order tests, especially in emergency situations, even though those tests may have been recently performed up north.
It took Forbes to point out one major cause of the problem, and Bill Neil, chief information officer at IRMC, agrees with the magazine.
According to Forbes, consumers, hospitals and physicians are now facing “a new Tower of Babel” created by competing electronic medical records systems. The American Recovery and Reinvestment Act mandated that hospitals and individual doctors adopt “meaningful use” of electronic medical records or EMRs by January 2015 but as Forbes puts it, “one company’s EMR system isn’t particularly compatible with the EMR system from another company.”
In fact, despite an estimated $14.6 billion paid out by the Centers for Medicare and Medicaid Services (CMS) to help hospitals, healthcare systems and physicians upgrade electronic medical record keeping, but the various software and computer systems created by the free market do not always “play well together.” In other words, sending and receiving EMRs from, say, Darien, CT to Vero Beach remains something of a crapshoot.
Even if a Florida physician requests and receives your medical records in electronic form, there’s no guarantee he or she will be able to read whatever is sent unless both parties are using compatible software, and without those records, doctors must either order new tests or risk possible malpractice lawsuits.
The lack of access to patient records may also contribute to the other category of unnecessary tests, such as EKGs when there is no evidence of heart problems. Flying blind, doctors may over test as a way of making sure all their bases are covered and nothing is missed when dealing traveling or winter resident patients they are not familiar with, even when there is not red flag pointing to a problem.
Which is not to say some doctors don’t over test for profit; rather, the scope of the over testing problem has several sources and incompatible record systems are a major factor.
In fact, as Neil admits, just getting medical records from across the street can create information technology headaches.
IRMC, explains Neil, uses a McKesson Paragon software suite while the HealthSouth hospital’s physicians generally employ software from Cerner Corporation. Getting the two software systems to “play well” together, according to Neil, “was a constant struggle,” but thanks to a close personal and working relationship with the CIO at HealthSouth and many hours of code-writing, a solution has been hammered out.
There are, however, more than just two software systems in use nationwide. Some of the leading players in the field, according to the CMS, are Epic, MediTech, CPSI, Cerner, McKesson, Healthland, Healthcare Management Systems, Allscripts and NextGen Healthcare. Only three of those companies were able to increase their market share last year. With dozens of ambitious smaller firms also seeking a slice of what is projected to be a multi-billion-dollar-a-year pie, real uniformity seems a long way off.
One potential solution, says Neil, is the use of “patient portals.” Patient portals offer patients the opportunity to have their medical records on what amounts to a secure website that would be accessible to any doctor in any state. But Neil says he also knows there are many people who aren’t comfortable or experienced with computers and, he admits, web security can always be an issue. Earlier this month, hackers broke into Anthem health insurance’s computers and made off with some 80 million Social Security numbers, birthdays, addresses, email addresses and income data for customers as well as Anthem’s own chief executive.
Fortunately, IRMC’s IT guru has a simpler solution. “We have people coming into our medical records department every day,” Neil explains, “for a CD or thumb drive copy of their medical records” preferably in universally readable formats such as PDF, JPEG or even Word documents. That’s an infinitely less bulky alternative to carrying file folders filled with paper medical records and x-ray film. Neil says patients everywhere should be able to get copies of their records that way from any healthcare provider.
While the Wall Street Journal reported Tuesday that “Electronic-medical-records systems may soon start speaking the same language,” there is little hard evidence to back up that claim. The firms the Journal says are planning to work in unison account for only 44 percent of all patient records so a software solution to today’s “Tower of Babel” is still a ways away.
And for the record, no software update will ever totally eliminate excessive medical testing, let alone Medicare fraud, but having a copy of your electronic medical records with you could make unnecessary testing far less common, save you money and even help save your life in an emergency situation.
