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Health Aff (Millwood). 2014 Jul;33(7):1271-7. doi: 10.1377/hlthaff.2014.0023.

No evidence found that hospitals are using new electronic health records to increase Medicare reimbursements.

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Julia Adler-Milstein ( is an assistant professor in the School of Information and in the Department of Health Management and Policy, School of Public Health, both at the University of Michigan, in Ann Arbor.
Ashish K. Jha is a professor of health policy and management at the Harvard School of Public Health, in Boston, Massachusetts.


The recent uptick in hospital adoption of electronic health records (EHRs) has been accompanied by growing concerns among some policy makers that hospitals may use these systems to select billing codes that reflect more intensive care or a sicker patient population in order to generate more revenue through higher reimbursements. Such "upcoding" would increase overall health care spending. We used national data to examine whether new adoption of EHRs was associated with increases in coded patient acuity or Medicare payments. We found that hospitals that adopted EHRs increased billing to Medicare, but at a rate comparable to that of matched controls of non-EHR adopters. In our difference-in-differences models, patient acuity and payment per discharge were essentially the same between adopters and nonadopters. We also failed to find a relationship between adoption and either patient acuity or payment within groups of hospitals that may be more likely to use EHRs to increase coding and revenue, such as for-profit hospitals and those in highly competitive markets. Thus, we found no empirical evidence to suggest that hospitals are systematically using EHRs to increase reimbursement. Our findings should reduce concerns that EHR adoption by itself will increase the costs of hospital care.


Cost of Health Care; Hospitals; Information Technology; Medicare

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