I find myself on the horns of an ethical dilemma. (Not the ethics of a horny dilemma; get your mind out of the gutter!) The proliferation of electronic medical records (EMRs) has generated a situation that really roasts my beef, and I am seeing it with increasing frequency. It's the flip side of the lawyers' old canard,
If it isn't documented, it didn't happen.It seems that more and more doctors are taking that to mean that if something IS documented, then whether or not it actually happened is moot, at least as far as payment is concerned.
There are at least two specialist offices who regularly send me letters documenting examinations that I know for a fact did not occur. In one case, the proof is that they document procedures requiring a level of patient cooperation and vocalization incompatible with the patient's age. (ie, How do you get a two-year-old to tell you in which ear the tuning fork sounds louder?) In another, a full body exam is documented at each visit when only the affected limb was examined. Those are the only two where my level of certainty is 100%. There are many others that are highly questionable, but harder to prove because of patient unfamiliarity with examination procedures.
What's the big deal?
What most patients don't understand is that physicians get paid on the basis of what they write down. Of course, the documentation is supposed to accurately reflect what was done, but when the auditor comes along, all that matters is the paper trail. So if a doctor spends a great deal of time with a patient performing a complex evaluation but only writes a few words, he's at risk of not being paid; whereas if he writes pages of stuff that never happened, no one bats an eye. Most of the time, no one will ever know.
Here's the dilemma: what, if anything, can I do about this? More to the point, what should I do?
I've spoken to the first office in the past. They claimed they had done all the procedures documented, and then offered to come over to my office to help me implement an EMR myself, given that they had just spent $250,000 on their new one and really liked the way it enhanced their income. The other office only started doing this more recently, and frankly the combination of anger and frustration has resulted in paralysis; I haven't talked to them about it either.
Besides, what would I say?:
Me: You're documenting fraudulently.
Them: So what? You can't prove it.
What else can I do? Is it worth trying to blow the whistle on these guys? I'm certain they'd easily survive any insurance audit, because the only way to prove them wrong is to call each patient and say, "Did the doctor do a complete physical exam each time you went for your broken foot?" Who's going to remember? More importantly, who's going to bother?
So all I can do is sit here fuming while these specialists laugh all the way to the bank. And the Obama administration wants to increase the prevalence of EMRs. Does anyone wonder why health care in this country is so expensive?