#Epic #Systems epitomizes everything perverse about the commercialized mess that American medicine has become.
“Epic’s clients are not doctors.
They are the CEOs and CFOs who write the checks to Epic,” says Dr. Bill Stead, who created pioneering #electronic #health #record systems at Duke and then at Vanderbilt University Medical Center,
both eventually supplanted by Epic.
Epic became the dominant vendor of databases because it was better than anyone else at combining regulatory compliance with 🔸maximizing hospital income.
Epic enables the hospital to maximize the use of codes that determine the payment.
“Before Epic, nobody was able to systematize upcoding,” says an executive of one hospital system.
🔥Epic’s software can enable doctors and hospitals to overcharge patients, insurers, and Medicare and Medicaid.
There are about 10,000 possible billing codes that indicate conditions and complications.
These #Hierarchical #Condition #Category (HCC) codes allow increased payments based on risk.
For instance, diabetes with no complications, HCC code 19, pays a capitation rate of $894.40 -- while diabetes combined with kidney failure can use 2 HCC codes, 18 and 136,
which increases the capitation rate to $1,273.60.
Doctors have the ability to also use codes for past patient conditions that have nothing to do with current presenting symptoms.
Assigning codes to each patient health malady is more of an art or artifice than a science, where doctors’ judgment calls can bleed into Medicare fraud.
Payments are based partly on time spent with a patient, on a scale from 1 to 5.
One doctor told me that her supervisor, who gets reports from Epic on her billing practices, regularly contacts her and says things like “That appointment was a 2. Don’t you think it might be a 3?”
Epic’s software can thus enable doctors and hospitals to overcharge patients, insurers, and government agencies such as Medicare and Medicaid.
Before a doctor can complete the record of a patient visit, they must respond to every question and check every required box.
🆘 Hospitals have financial incentives to make patients look sicker so that they can maximize revenue, and Epic’s software facilitates this.
https://prospect.org/health/2024-10-01-epic-dystopia/
