Megan McArdle expresses her disappointment that EMR is not saving money. I think that a lot of people have been under the impression that increases in efficiency would lead to cost savings. In many contexts, that’s true, but it became pretty obvious to me pretty early on that EMR was not one of them. Among other things, EMR makes billing more inefficient.
While so many conversations about health care costs focus on overbilling and fraud, often left unsaid are the fact that non-fraudulent doctors frequently underbill. There are things they could get paid for if they approached their records a little differently. It’s one of the things we have to worry about if we start trying to bend the cost curve by cutting physician fees. The more we do that, the harder they will look. Or, maybe, it actually doesn’t matter because of EMR. EMR is, among other things, allowing hospitals to more easily find the billing they could send out but don’t. As it stands, my wife’s employer checks doctor notes once every now and again and gives doctors tips on the things that they forgot or didn’t know to bill. With EMR, the review process would become a lot more streamlined
Interestingly, I think that McArdle may have been more right than wrong in her initial view of EMR (cost-savings aside). There is a huge learning curve, and people who have been doing notes one way for the longest time are going to be slower during the adaptation process (which may last the duration of their career…). But for doctors who learn to use EMR initially, I think it’s more likely than not a time-saver. My wife came through under both systems and it didn’t take long for EMR to be the faster way to go. She initially hated it, but now really wishes her current employer would adopt it. But she hadn’t spent years and years doing it the other way.