ICD-10 Benefits

ICD-10’s Role in Furthering Population Health

Jason Gottlieb

by Ken Bradley courtesy of ICD-10 Monitor

When said in the company of clinicians, the term “ICD-10” may elicit grumbles or at least concerned looks – a somewhat understandable sentiment. Ranked as a top initiative in numerous provider surveys, ICD-10 requires detailed transition planning, multiple technology upgrades, and a considerable amount of training. The amount of information clinicians and staff must learn – especially the new code set and clinical documentation requirements – is substantial.

How substantial? Think back to your school days. How would you have reacted if your kindergarten teacher announced that the alphabet no longer had 26 letters, but 130, or if your high school chemistry teacher told you to memorize the periodic table – and by the way, it recently expanded from 118 elements to 590?

Certainly, the fact that ICD-10’s code set is five times larger than that of ICD-9 seems to present a steep learning curve. Fractures, for example, have 17,099 ICD-10 codes, as opposed to 747 with ICD-9, while poisoning and toxic effects will have 4,662 codes rather than 244. ICD-10’s learning curve isn’t solely due to the increase in codes, either; the new level of detail and specificity required in clinical documentation is just as significant. Diabetes documentation, for instance, must include the diabetes type, body systems affected, any complications or manifestations, and a secondary code if long-term insulin use is required.

While clinicians and staff may be wincing at the amount of new information they must be ready to put into practice by Oct. 1, 2015, ICD-10’s benefits to providers are undeniable. In particular, ICD-10 can further population health initiatives, the main focus of Meaningful Use Stage 3. The new code set and additional clinical documentation requirements, the very items creating a huge learning curve for providers, also can promote population health in four key ways:

1) They ensure that patients with chronic conditions receive the best care, according to the latest research and protocols. ICD-10’s extra granularity will require physicians to document more specific and current protocols for patients in certain populations. Physicians also will be able to analyze patient data to identify trends in certain populations. As a result, they can study the effects of treatment protocols and identify patterns by criteria such as gender and age.

2) They help identify patients at risk for chronic conditions. Beyond enhancing care for patients in certain populations, ICD-10 can help physicians identify patients at risk for diagnoses such as diabetes and hypertension. The precise nature of the code set can allow providers to set parameters to flag patients who fall into certain categories that indicate a pre-disease state. Physicians then can take preventive measures with patients, for instance focusing on diet and fitness initiatives to help lower blood pressure.

3) They facilitate outreach and knowledge-sharing with other providers. ICD-10 will enable providers participating in accountable care organizations (ACOs) or other risk-sharing models to share comprehensive, thoroughly documented patient information easily. For that matter, any provider giving or receiving a referral will be able to exchange robust and standardized patient data, which will promote more informed care decisions and better outcomes.

4) They result in the reporting of data regarding population health and effectiveness of treatments. Through ICD-10, researchers can more easily obtain data such as medication lists and orders, allowing them to study demographic groups, evaluate and enhance treatment protocols, and make other research-related improvements. Researchers will be able to get the data they need electronically and in a standardized, apples-to-apples format. Granted, we won’t reap the benefits of this type of reporting for several years, as researchers need time to develop a baseline with the new code set. Nonetheless, it will create unprecedented ease of use and access to patient data.

In addition to supporting population health, the depth and precision of ICD-10’s data has another helpful application: value-based reimbursement (VBR). With VBR, providers are frequently required to submit more comprehensive data than they have in the past. The more precise code set allows providers to increase the accuracy of claims. The expanded clinical documentation can help illustrate why physicians made certain treatment decisions, how much the patient’s health has improved, and what barriers may have stood in the way of this improvement. This more exact reporting can mean the difference between a paid or unpaid claim, and in the long run, it can have a major impact on the provider’s bottom line.

Essentially, ICD-10 is granular enough to allow for the documenting of nuanced patient conditions in much more detail, and that’s the very characteristic that can make transition planning a bit daunting or even tedious. The payoff is well worth it, though. In a recent Advisory Board Company survey, nearly three-fourths of responding provider CFOs agreed that managing the health of populations is critical. These CFOs indicated that they’re making huge investments to create an accountable care system so they can ensure better population health. Because ICD-10 can support a variety of population health initiatives by providing the necessary data, it can jump-start providers’ efforts without significant added costs (beyond the necessary investments for transitioning to ICD-10).

In the throes of a multi-hour, intensive educational session, trainees may question whether ICD-10 is worth it. Going back to an oversimplified but universal example, it’s like memorizing the alphabet, which lays the foundation for the lifelong enrichment obtained from reading for education and enjoyment.

Similarly, ICD-10 sets the stage for any number of population health initiatives that identify trends in certain demographics and disease states, validating clinicians’ longtime assumptions and advancing treatment protocols – and ultimately, it will improve the health of numerous populations for years to come.

About the Author

Ken Bradley, vice president of strategic planning and regulatory compliance and one of Navicure’s founding members, is responsible for assessing markets, monitoring government regulatory requirements and providing competitive analyses to develop strategies and solutions that ensure Navicure and its clients continued success in an increasingly complicated business environment.

He is responsible for all Navicure industry transitions, including ICD-10 and 5010. He has given educational presentations and written several articles on 5010 and ICD-10.

Five Ways ICD-10 Helps Providers Reach Care Collaboration Goals

Jason Gottlieb

by Ken Bradley, Vice president of Strategic Planning and Regulatory Compliance at Navicure, a provider of cloud-based healthcare billing and payment solutions (courtesy of ICD-10 Monitor).  See full article here.

A coordinated experience only happens when the right people have the right data at the right time. Healthcare collaboration is crucial to our daily lives. That’s why care coordination is central to healthcare reform: it can remove the fragmentation and communication barriers that impede efficiency, collaboration, and informed decisions.

Agreeing on care coordination’s importance is easy for providers; achieving it, however, is the difficult part. That’s where ICD-10 can help. At first glance, it may not seem directly related to the success of care coordination; however, ICD-10 can be a catalyst in five key ways:

1) Providing specificity for today’s patient care and provider needs. When the U.S. healthcare system implemented ICD-9 in 1979, providers had different business and clinical data needs than they do today. On the business side, reimbursement models, patient billing, and technology have all advanced exponentially; activities such as claims submission require more detailed and complex data. On the clinical side, advances in medicine, more complex care needs, and the need for additional diagnoses to describe patient condition in greater detail have created the necessity for more breadth and depth in coding and documentation. In short, we’ve outgrown ICD-9, and ICD-10 is a good fit.

2) Laying a foundation of standardized, comprehensive patient clinical data. Lack of detail in clinical documentation can lead to miscommunication, the need for repetition of tests, and requests for clarity – all of which can be costly. ICD-9’s narrower code set contributed to these issues, but ICD-10 allows everyone to describe clinical documentation with the same, much more specific code set. The language is more specific, accurate, and comprehensive. As interoperability provides a vehicle for sharing data, ICD-10’s standardization and thoroughness can ensure that all parties who access this data are able to get what they need.

3) Promoting a better understanding of each constituent’s role in a patient’s care plan. An aging population, higher incidences of multiple chronic conditions, and a multilingual population all create more opportunities for miscues and a lack of understanding. ICD-10 allows for primary care physicians, specialists, therapists, and nurses to share the same detailed data; consequently, they don’t have to start at square one when consulting with patients for the first time. As a result, patients can have a more coordinated care experience while all parties can more effectively collaborate regarding treatment plans.

4) Including advocates, researchers, and other parties who contribute to the advancement of healthcare. With ICD-10, healthcare collaboration can expand to include researchers and other constituents who need standardized yet detailed data. These constituents may not directly interface with patients during the care continuum; however, they can make important contributions such as medical advancements and protocol enhancements.

5) Paving the way for more treatment accountability. Moving forward, one of the most challenging but important components of care delivery is patient involvement. Meaningful use (MU) has addressed patient engagement by promoting e-communications and the use of portals, but providers may need to involve patients on a deeper level. In particular, providers must find ways to improve patient adherence to care plans as value-based reimbursement becomes more prominent.  In the future, the detail required by ICD-10 may assist in allowing providers to keep track of patients’ follow-up activities, follow-up results, and patient response to treatment plans to ensure that they are involved and following treatment recommendations.

Care coordination can only be achieved if healthcare’s silos and communication barriers are removed. ICD-10 plays an integral part in this by providing a data set that gives all parties the information they need. As interoperability becomes more ubiquitous, it also has the potential to create widespread variation in patient data. ICD-10’s standardization can allow us to reap the benefits of interoperability and achieve a collaborative and coordinated care continuum that promotes greater efficiency and better outcomes.

The Benefits of ICD-10: Improved Claims Processing

Jason Gottlieb

Much of the delay in healthcare claims processing comes from insurance companies’ requests for supporting medical documentation.  This, in and of itself, a byproduct of the relative dearth of information the outdated ICD-9 coding system provides on the submitted claim.  The assembly and submission of patient records and the subsequent time for the insurance company to review those records and render a determination can add 60 days or more of additional processing time and untold costs for both sides of the claims processing equation.

The promise of ICD-10 is that more specific descriptions of patient conditions and the services used to treat those conditions will enable insurance companies to render payment determinations without the need to request additional documentation.  In a recent interview with RevCycle Intelligence, Pam Jodock, Senior Director of Health Business Solutions for the Health Information & Management Systems Society (HIMSS) articulated how the increased granularity and specificity of ICD-10 coding can lead to a more efficient claims processing cycle with insurance carriers.

“There should be fewer claims pended for requests for medical records because the ICD-10 code will provide the information not included in ICD-9 codes today,” Jodock says. “Hopefully over the course of time, we’ll see a streamlining of claims payment and providers will see a reduction in the number of claims that get pended or rejected at first pass.”

In addition, providing details in the form of coding related to social, psychological, economical, and clinical circumstance allow providers to better defend the severity of their respective patient populations.  Jodock states, “Providers can only control a small portion of outcome with their patients. There are other things — comorbidities, lifestyle choices and adherence to medication protocol — that will impact outcome,” claims Jodock. “The more of that type of information that providers are able to capture, the better able they’ll be able to account for those factors when negotiating appropriate reimbursement levels.”

With 6 months to go before October 1, documentation and coding proficiency in ICD-10 is pre-requisite to achieving revenue cycle and claim processing efficiencies.  Continue to check in with ICD-10 AnTENna for tools and resources to ready your department for October 1, 2015.

 

The Benefits of 10: Coding Preventable Medical Error

Doug Zweibel

by Rhonda Butler, senior clinical research analyst with 3M Health Information Systems.

See full article here.

Preventable errors in hospital care are the third leading cause of death, after cancer and heart disease. Updated estimates in a 2013 study in the Journal of Patient Safety say that between 210,000 and 440,000 people die in US hospitals every year because some preventable harm was done to them. The Office of the Inspector General published its own 2010 estimate only for Medicare patients, determining that poor hospital care was a contributing factor in the deaths of 180,000 of them. Even the universally accepted and much older number (published in 1999) of 98,000 is widely considered a “crisis” and a “national priority” in health care. And remember, these numbers don’t even attempt to quantify the financial and human toll of poor quality care that doesn’t kill people, but just costs us money and time and causes needless suffering.

Why can’t we accurately track something this important? Because ICD-9 lacks the detail to allow complications and errors in medical care to be easily entered in the permanent medical record so these events can be accurately measured. And as the saying goes, if you can’t measure something, you can’t understand it, and if you can’t understand it you can’t control it.

ICD-9 codes are pitifully inadequate for measuring the occurrence of preventable medical error. Instead of talking about the dumbest ICD-10 codes, we should be demanding the ICD-10 codes we need to start measuring and understanding and controlling these totally unnecessary healthcare costs.

Here are just a few examples that show the difference between what you can say about complications, adverse effects, and errors using ICD-9 and what you can say using ICD-10.

ICD-10 says T36.0X5A Adverse effect of penicillins
ICD-9 says 995.29 Unspecified adverse effect of other drug, medicinal and biological substance

ICD-10 says T88.4 Failed or difficult intubation
ICD-9 says 999.9 Other and unspecified complications of medical care, not elsewhere classified

ICD-10 says T88.51XA Hypothermia following anesthesia, initial encounter
ICD-9 says 995.89 Other specified adverse effects, not elsewhere classified

ICD-10 says T86.822 Skin graft (allograft) (autograft) infection
ICD-9 says 996.79 Other complications due to other internal prosthetic device, implant, and graft

ICD-10 says R57.1 Hypovolemic shock [shock from severe dehydration]
ICD-9 says 785.59 Other shock without mention of trauma

ICD-10 says Z20.6 Contact with and (suspected) exposure to human immunodeficiency virus [HIV]
ICD-9 says V01.79 Contact with or exposure to other viral diseases

ICD-10 says I97.711 Intraoperative cardiac arrest during other [non-cardiac] surgery
ICD-9 says 997.1 Cardiac complications, not elsewhere classified

ICD-10 says J95.71 Accidental puncture and laceration of a respiratory system organ or structure during a respiratory system procedure
ICD-9 says 998.2 Accidental puncture or laceration during a procedure, not elsewhere classified

What matters about codes is not how many there are, but how precise they are. If heaven forbid you or someone you care about suffers the consequences of a preventable medical mistake, look at the way it will be entered on the permanent medical record in ICD-10, and then look at how that exact same condition will be recorded in ICD-9. Lobbyists are fighting tooth and nail to keep using the ICD-9 system. Letting a few animal bite codes stop us from using the power of ICD-10 to measure and understand and begin to control preventable medical errors—really, how dumb is that?

ICD-10: Defining Clearer Boundaries

Doug Zweibel

by Rhonda Butler, senior clinical research analyst with 3M Health Information Systems.

See full article here

What makes a species distinct enough that it gets its own unique name?  Like any classification system, Linnaeus’ conceptual framework for organizing and naming living things is an exercise in drawing boundaries.  Similar things are grouped together, initially by laying out general boundaries—is it animal, vegetable, or mineral?—and making progressively finer distinctions.

All classification systems work in basically the same way, because all classification systems are products of the human mind. Classification is a profoundly human endeavor. We invent systems that allow us to organize and codify our understanding of the world and ourselves.

ICD-10 is a classification system for understanding the ways our own bodies can break or be broken, and what we can do to try and fix them. ICD-10 has more codes than ICD-9 simply because it makes finer distinctions.

To the extent possible, classification systems try to ask for the same amount of detail in drawing a next level boundary. Often this is depicted in graphic form like a tree structure—the kind of thing we see in a company’s org charts all the time. As it evolved with each annual update, ICD-9 did not make a serious attempt to be systematic in the detail it added, or consistent in the types of information it classified to the same level boundary.

ICD-10 is both systematic in its application of detail and consistent in the type of information it classifies to the same level boundary. For example, the American Congress of Obstetricians and Gynecologists (ACOG) asked the CDC’s National Center for Health Statistics (NCHS) to add detail to ICD-10 that tells them whether a pregnant woman is in the first, second or third trimester of her pregnancy. So that information about trimester of pregnancy was added systematically to the obstetrics branch of the ICD-10 tree.

Systematic and complete application of detail to an entire branch of a classification system obviously increases the number of codes by a factor of the amount of meaningful detail—three trimesters = three times as many pregnancy diagnosis codes.

And that is of course the point of any good classification, to draw boundaries that are meaningful to the people in that field. Imagine telling ACOG that all trimesters are the same, that the information they asked for in ICD-10 is unnecessary and a burden to physicians, and that they can track quality, outcomes, and do sophisticated clinical research without knowing the trimester of the patient. Maybe the opponents of ICD-10 can tell them.

ICD-10 Data: Why U.S. healthcare needs to move on from ICD-9 coding

Jason Gottlieb

by Carl Natale, ICD-10 Watch

When ICD-10 opponents say there is no benefit for patient care, they’re refusing to connect data to healthcare. It’s not hard to see why.

It’s not like physicians can see a patient recover as their symptoms are documented. So there’s no clinical reason why U.S. healthcare needs more data.

Except data isn’t medicine. It doesn’t work that way. It accumulates over time to give healthcare professionals a picture of how treatments and diagnoses develop. That data can give physicians better ideas on how to treat their patients.

How much ICD-10 data do we need?

It’s hard to understand why U.S. healthcare needs data on turtle and jet engine injuries. Except someone with a medical degree argued for the inclusion of some “bizarre” codes. But those kinds of diagnosis codes are relatively few. There are more important specifics to focus on:

  • Much of the specificity is due to laterality (right or left side).
  • Also the new details included in the codes will help link symptoms and identify patients at risk of developing serious health problems.
  • The precision allows for better tracking of care after the initial patient encounter. The information can be used to develop better care after treatment.
  • Such specificity will help identify fraud, waste and abuse in medical claims. “Was the same procedure performed twice? Were conflicting claims filed for the same patient?”

And the better, more precise the data will help physicians make better decisions because they can see trends if they look at healthcare data.

How much time do we need for ICD-10 data to matter?

Again, the problem with this is that it’s going to take time to realize those benefits. Physicians and patients like short-term benefits. Take your medicine and you start to feel better in days or weeks. But it could take years to see these benefits.

All the knowledge that physicians use to diagnose and treat patients took years or decades or centuries to accumulate. Medicine is the result of careful study that takes time. And ICD-10 codes will help them accumulate data that leads to new treatments.

Will ICD-9 codes kill anyone?

Not likely. But medical uncertainty can. And it’s practically impossible to connect that with a lack of specificity in ICD-9 codes.

Just a little more specificity has got to help. And maybe ICD-10 codes can give us enough information about what we do not know that U.S. healthcare can advance treatment.

It’s a big maybe that comes at a cost for medical practices. But physicians deal a lot in maybes when they diagnose patients. Let’s use ICD-10 codes to get rid of a few maybes.

The impact of ICD-10 specificty on hospital operations

Jason Gottlieb

Edifecs, a healthcare technology company, recently conducted a survey of 454 industry representatives to identify what areas of hospital operations would most benefit from the increased specificty ICD-10.  The chart below summarizes the opportunities.

ICD10CodedData-01-e1414710734879

Given current reimbursement methodologies, these results are not surprising.  However, as more ICD-10 claims data becomes available, it is reasonable to assume that the industry will strive to adjust coverage guidelines, medical necessity criteria, coding and billing requirements, and quality defintions.

ICD-10 is the Pathway to Big Data in Healthcare

Jason Gottlieb

by William Rusnak, MD

See full article here

If big data in healthcare is the future for medicine, then ICD-10 is the way to get there.

Forgetting the idea that this coding system is largely designed for better billing and that providers will eventually be forced to make the switch, let us take a look at the benefits of ICD-10.

Although I’m well into my medicine career, I still think of myself as a struggling musician — a guy’s got to dream. Anyway, when recording in a studio, artists know all to well that when it comes to sound, poor-quality equipment will produce poor-quality audio, despite the development of truly impressive recording software. The same goes for medical data. The current coding system, ICD-9, is inflexible and far from comprehensive. “Garbage in” is a great way to describe it.

ICD-10 is an enormous expansion and at first glance seems excessive. Realistically, though, there is a finite amount of actions that a provider or patient can perform — or have happen to them. ICD-9 doesn’t even come close to meeting the descriptive needs of today’s environment. Alarmingly, there isn’t a code for Ebola. ICD-10, on the other hand, has 68,000 codes available for recording any diagnosis we can possibly imagine (plus ~72,000 more for procedures). Yes, it is comical and almost insane that some of the codes exist — see struck by a turtle and injured by a spacecraft — but that’s what being comprehensive is all about. Very often, physicians will conjure up the most unlikely, rare diagnoses for their differentials, but if they aren’t thinking about these “zebras”, they’ll never detect the one-in-a-million disease when it matters.

Ultimately, we are now in the world of “big data”, though very early in this new era. Our computing power is more than enough to adequately record human behavior in vital situations like receiving medical treatment and we need to capitalize on it. If a patient suffers the rarest of occurrences or undergoes an abstract procedure, there should be a code for it. Likewise, when a physician performs a specific procedure, a code should represent it in detail, including any variations. The first leap into big data is collecting it and that needs to be done with precision. Quality in, quality out.

We need to measure it to fix it

Some of the greatest success has been achieved by “going with the gut,” and often that is all a person can reply upon when making a decision. However, if there is a choice between proceeding blindly or having a team of scouts handing you an organized report detailing the outcomes of similar situations, most people will choose the latter. When decision-making is needed, life is simply better with data. If used properly, it can shed light upon complications within our systems that we otherwise would have overlooked. Google goes as far as saying that analyzing data will make us smarter, allowing us to anticipate problems before they occur.

As an example, look at nutrition. From my experience, when asked, many people will tell you that they “eat a pretty normal diet.” Now, make a decision with that data. Not very helpful, is it? Sure, a quick glance at the person can provide you with an answer like “it looks like it’s working,” but what advice can a physician or nutritionist possibly give without having the necessary details of the person’s diet? The same holds true for the rest of medical practice. Without measuring everything that we are doing in healthcare, improvement of our systems is going to be excessively difficult. A bird’s-eye view will be achieved when every medical organization in the country — eventually the world — is tracking events and outcomes with ICD-10. Only then will we have enough information to begin making the impactful changes needed to mend today’s broken system.

Public health, research, and quality improvement

As we finally move into this era of big data, consider the implications on public health and research. If our healthcare system is accurately collecting information about diseases and treatments in the form of codes, access to patient charts wouldn’t even be needed. The data would already be clean and organized, a scientist’s dream. Relationships between outcomes and treatments would quickly be revealed, allowing for optimization. Developing epidemics could be spotted significantly earlier. We will be able to learn in weeks what used to take years.

Last, data overload is a valid concern, but technology will help to “filter the noise” and facilitate the creation of plentiful, pertinent, organized, actionable data (not quite as catchy as “big data”, I know). Physicians will enjoy the luxury of practicing evidence-based medicine while the data unfolds in real-time. The old way of “keeping up with the literature” by reading medical journals each month will become extinct.

Big data is the future and for medicine, ICD-10 is the way to get there.

Coalition for ICD-10 Responds to AMA President Dr. Robert Wah

Jason Gottlieb

In his recent speech to the AMA House of Delegates, AMA president Dr. Robert Wah characterized the planned implementation of ICD-10 as analogous to the dark forces controlling the galaxy in the movie Star Wars:

“If it was a droid, ICD-10 would serve Darth Vader… For more than a decade, the AMA kept ICD-10 at bay – and we want to freeze it in carbonite!”

Dr. Wah’s attempt at humor is unfortunate because the quality and precision of our national health care data is a serious matter. In this country, we use coded data to assess quality of care, make benefit coverage decisions and to determine physician and hospital payment. The financial viability and performance assessments of hospitals and physicians are impacted by the data. Yet we continue to rely on an outdated 1970s-era coding system for reporting diagnoses and inpatient hospital procedures.

In his speech, Dr. Wah goes on to lament:

“Sucked into a jet engine? Burned by flaming water skis? Yes, there are codes for that.”

While at first glance these examples appear humorous, it is important to understand that these cause of injury codes were included in ICD-10 to meet the needs of organizations like the Department of Defense (aircraft accidents are an important issue for the military) and Worker’s Compensation (in waterski shows the burning waterski trick can lead to a worker’s comp claim). Should our national coding system ignore the needs of the Department of Defense and Worker’s Compensation?

Using cause of injury codes to imply that the coding detail in ICD-10 will be a burden to physicians is at best disingenuous because physicians are not required to report cause of injury codes, except in very limited situations such as injuries caused by medical treatment, like removing the wrong limb. Furthermore, the current ICD-9 system has similar cause of injury codes and their existence has never been a burden.

Dr. Wah continues to criticize by stating:

“We’d see 13,000 diagnosis codes balloon into 68,000 – a five-fold increase.”

Again, the inference is the increase is unnecessary and will be a burden for physicians. This is like saying the English language is a burden to use because there are 470,000 words in Webster’s unabridged English dictionary. Just as no one is expected to know rarely used words like floccinaucinihilipilification or use all 470,000 words, physicians and other providers will only use the codes relevant to their patient population (e.g., an ophthalmologist will primarily use only the eye codes).

The notion that more codes create a burden is out of touch with today’s digital world. As with almost everything else, there’s an app for that. In fact, there are more than 50 ICD-10 iPhone apps that allow a person to use word search to find an ICD-10 code instantaneously. Ranging from $1.99 to $10.99, the cost isn’t a burden (there are even a few free versions).

Dr. Wah complains about the number of codes and the detail in ICD-10 but fails to mention that much of the additional specificity in ICD-10 was at the request of medical specialty societies. Nor does he mention that there are no ICD-9 codes for many critical healthcare issues. There is no code to report and track Ebola. There are inadequate codes for tracking service-related health problems for our veterans. There are no codes to help us research sports-related concussions among young athletes. It’s hard to understand why the AMA is not demanding that this kind of information be available in our national data.

Dr. Wah goes on to state:

“We all know ICD-10 is expensive to implement. We don’t know if it will improve care.”

While there are significant costs associated with the implementation of ICD-10, the vast majority of the health care industry has already incurred those costs. In our digital world, the infrastructure for a systems change like ICD-10 has to be built and tested well in advance. These are sunk costs which will be lost if ICD-10 is not implemented. Indeed, CMS has estimated that the health care industry has already invested billions in preparation for ICD-10: “Forgoing ICD-10 translates into a loss of up to $22 billion for the U.S. health care industry” (Federal Register, 77(172), p 54689).

As to whether ICD-10 will improve care, it would seem obvious that more precise data should lead to better identification of potential quality problems and assessment of provider performance. There are multiple provisions in current law that alter Medicare payments for providers with excess patient complications. Unfortunately, the ICD-9 codes available to identify complications are woefully inadequate. If a patient experiences a complication from a graft or device, there is no way to specify the type of graft or device nor the kind of problem that occurred. How can we as a nation assess hospital outcomes, pay fairly, ensure accurate performance reports, and embrace value-based care if our coded data doesn’t provide such basic information? Doesn’t the public have a right to know this kind of information?

Our national healthcare data is broken due to the use of an archaic coding system. Given Dr. Wah’s “freeze it in carbonite” comment, it is clear that he is not really interested in a delay of ICD-10 but instead wants ICD-10 to never be implemented. It is hard to fathom why anyone would promote having our national data fail to meet the demands of 21st century health care. This is especially perplexing given that ICD-10 has been adopted by virtually every other country.

In attempting to relegate ICD-10 to the equivalent of “a galaxy far, far away,” Dr. Wah inexplicably ignores the implications for U.S. health care if we continue to use ICD-9 codes. This isn’t about waging a mythic battle (with sound bites instead of light-sabers). It’s about improving quality of care and patient safety in the here and now. It’s about ensuring fair payment, and in the case of Ebola, it’s about protecting our citizens. Yoda from Star Wars said it best: “Always in motion is the future…a little more knowledge lights our way.”

Applying Transparency to ICD-10

Jason Gottlieb

by Mark Spivey, ICD-10 Monitor

For full article, click here

“Transparency” is a term typically reserved to apply to government entities or picture windows – not ICD-10.

But Greg Adams, vice president of the consulting division of Panacea Healthcare Solutions, says it applies to that, too.

“You may have heard about price transparency since there has been a lot of publicity around this topic with a recent study by the Catalyst for Payment Reform showing that two-thirds of states received a failing grade for their healthcare price transparency laws – while another seven states squeezed out a D grade,” Adams noted, adding that only two states, Massachusetts and New Hampshire, managed an A grade.

“While the emphasis has been on price transparency,” he added, “I think of transparency in a broader perspective than just price.”

In its simplest terms, Adams explained, transparency in any market, the healthcare market included, is the ability to have sufficient information to compare the value of products.

“For healthcare this has recently been defined as quality over price,” he said. “Having this type of transparent information allows consumers to compare providers. In an economic sense, markets cannot function efficiently without transparency. If a buyer cannot distinguish the differences in price and quality between suppliers, then there cannot be an efficient market.”

As the U.S. healthcare industry amounts to something of an inefficient model, historically it has been “difficult, if not impossible” to compare hospital prices and quality, Adams added. But he also said the industry seems to be nearing a tipping points as patients become more responsible for a larger and larger portion of their healthcare bills.

“I believe transparency will happen, (and) it will happen fast. And it will be defined as price and quality – in other words, value,” Adams said. “We all agree that ICD-10 is connected to clinical documentation improvement, and clinical documentation improvement is connected to quality through the accurate coding of the medical record. And since quality is part of the value equation, remember that value equals quality/price.”

The bottom line?

“Coding in ICD-10 will result in a better reflection of the quality of care provided and improve transparency in healthcare,” Adams said.