Anthem tries to take its EHR dividend early

Anthem tries to take its EHR dividend early

Kevin, MD, in a post entitled Blending codes, aka HMO extortion, chastises Anthem Blue Cross Blue Shield of Ohio for blending two codes into a single rate that is much closer to the lower code. Here’s the argument:

  • EHRs allow providers to document their encounters more fully
  • The fuller documentation leads to higher (though appropriate) coding
  • Anthem doesn’t like the fact that more docs are documenting better and is basically disallowing the higher code
  • Kevin is worried that as this spreads, doctors nationwide are going to be penalized for adopting EHRs

Anthem seems to be acting shortsighted. Assuming that Anthem and other payers gain from EHR adoption, they should allow physicians to generate higher revenues through improved documentation. That will encourage adoption. Indeed, studies of the benefits of EHR adoption typically include “increased reimbursement from more accurate evaluation and management coding” among the benefits to physicians.

Once EHR adoption has increased to say 75 percent, it may be in Anthem’s interest to blend codes or reduce reimbursement for a given code. But with EHR adoption stuck at around 15-20 percent (at least in smaller practices) that point is nowhere near being reached. Anthem may cost itself more in the long run by taking away an economic incentive for EHR adoption.

May 7, 2006

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