The rules associated with it.
First, they look for any and all ways to deny reimbursement to healthcare systems. Is one thing missing from your doctor's documentation? Denial. Didn't get prior-auth for a needed procedure? Denial. Didn't jump through hoops by getting a series of unneeded tests? Denial. And the list goes on and on and on. It also changes every year and many of the changes are arbitrary and seem to change for the sake of change. Never mind the monumental cluster when the Affordable Care Act went into place.
Due to all this, it makes health care expensive. You're getting a bunch of stuff done you don't need and the government is denying certain things without any real cause which means the hospital either needs to get the money from the patient or just eat the cost...which they do for the most part.
Not to mention it's expensive to maintain all of this. I work with electronic medical records and the amounts of changes we need to make thanks to the government require us to have an 8 story building filled with several hundred IT staff just to manage all of it...and we're just one hospital. One of the previous companies I worked for had 70 hospitals across the US and we had nearly 2,000 employees just to maintain the electronic medical records.
Also since we are in the IT industry we need to be paid like it too, so these healthcare systems need to pony up some serious coin to keep senior level analysts or otherwise they'll jump ship. Thankfully, I can pretty much anywhere in the US and get a job though (why I choose Utah is still a mystery to me
).
Electronic medical records are excellent for patient safety and helping coordinate your care among all the physicians in a system (and for the most part outside the system too). But they are expensive and the government more or less requires you to use them. It really should be the choice of a healthcare system whether they want to use it or not and let the patient decide if it's an important safety feature or not (personally I'd never go to a place with paper charts).
All of this doesn't even touch on lawsuits and malpractice insurance costs, which are astronomical. If you're a raging alcoholic and die from liver failure, that's not the doctor's fault, it's yours and your family shouldn't be able to sue because of it. Or rather your family should be able to sue, but they shouldn't get awarded a dime.