Monday, November 28, 2011

ICD-10: Regulatory Burden or Pathway to Improved Health Care Services?

Yesterday, Dr. Jason D. Fodeman penned an Op-Ed piece in the Washington Post Examiner that “Congress should stop the coming medical billing fiasco” where he opined that the coming conversion to ICD-10 will do more harm than good. I can hardly disagree more with Dr. Fodeman.

In this post, I present a few questions and comments to Dr. Fodeman. I’ll present these questions and comments in the order by which Dr. Fodeman presented his viewpoint; and that’s all this post and Dr. Fodeman’s Op-Ed really is…a viewpoint, however biased we each might be. :)

Q1: Where’s the evidence that ICD-10 ‘regulations will do more harm than good?”

C1: In fact, ICD-10’s increased specificity will mitigate the need for providers (professionals and institutions) to submit additional information. I noted these clinical data elements in a post a short while ago. See Computer-assisted coding for ICD-10

C2: There are some silly and likely unneccesary codes in the new ICD version. They’ve made for some amusing articles and posts. I believe this WSJ article started the laughs Walked Into a Lamppost? Hurt While Crocheting? Help Is on the Way and went a long way toward exposing some of ICD-10's silliness. But how many providers and payers actually believe they’ll be required to submit codes for these silly conditions?

C3: No doubt that converting to ICD-10 is a non-trivial cost – for professionals, facilities, payers AND intermediaries. And these costs will be a drop in the bucket compared to the benefits that greatly enhanced care management, administrative efficiencies, benefit design, provider reimbursement, compartive effectiveness research and other improvements ICD-10’s specificity will enable.

C4: Not converting to ICD-10 epitomize the problems facing our nation's healthcare system: fractured care management programs, administrative inefficiencies, unrealistic benefit packages, inaccurate provider reimbursement levels and the inability to perform meaningful compartive effectiveness research.  Moreover, the pay-for-performance and quality management programs needed to really make an impact to our healthcare are enabled by ICD-10.

C5: All healthcare constituents have a stake in improving healthcare outcomes in the United States: patients, physicians, hospitals, payers and intermediaries. It seems self-serving for physicians to be leading the charge against ICD-10 with the somewhat aggressive stance that they are the only ones that will not benefit from ICD-10's modern age diagnoses coding capabilities.

Q2: What is the reason that providers are not already capturing and documenting the information necessary to properly code a complete diagnosis? If not, I suggest they are largely committing malpractice. I had an Aircraft & Powerplant license and a good mechanic would never think of not over-documenting the work they did – it was just good business sense - for the mechanic, the pilot and the passengers.

C6: I totally disagree that the ICD-10 mandate ‘will be onerous and frustrating for physicians” and that it’ll be "the patients that suffer the most from diminished care.” How could more accurate, detailed clinical documents, enhanced adjudication/payment processes, and the abilty to develop new procedures and care management programs via comparative effectiveness programs – all of which will be enabled by ICD-10 – diminish pateint care?

C7: I agree with Dr. Fodeman that CMS got the cart in front of the horse. ICD-10 and HIPAA 5010 compliance should have been mandated before Meaningful Use. But I suppose they thought hanging the MU carrot out before the ICD-10/5010 stick would be more palatable. Sort of like building the master bath and bedroom of a house before laying its foundation?

In closing, I’ll say once again – like Dr. Fodeman did in his closing paragraph – one can joke all they want about ICD-10 codes for being "bitten by turtle" and "struck by turtle"  - or, my personal favorite - "sucked into a jet engine, for the second time" - but that tack, to me, is a red herring attempting to diminish the true and real value implementing ICD-10 diagnosis coding offers the U.S. healthcare system.

Comments? Retorts?

1 comment:

  1. It is true that there is benefits to society to collect all these data. But is it fair to ask the medical clinics to pay for this transition so as to benefit society as a whole? Who is paying for this transition?

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