Guest Blog: Reasons Why ICD-10 Should Move Forward
Editor's note: This guest blog is written by Michael Sanderson, president of RemitDATA, and Torrey Barnhouse, president of TrustHCS.
The American Medical Association (AMA) House of Delegates recently voted to "vigorously work to stop the implementation of ICD-10 (International Classification of Diseases and Related Health Problems, 10th Revision) and to reduce its unnecessary and significant burdens on the practice of medicine."
The AMA's opposition to ICD-10 stems primarily from physician practice concerns -- which may be understandable. Physician practices will experience dramatic change under ICD-10. Simple one-page patient check-out forms and hand-written notes will no longer suffice. There will be heavy costs associated with training, technology changes, workflow disruptions and productivity losses.
Even at the hospital level some skepticism is appropriate. Can systems handle the data deluge and rectify wrongly coded claims? Will payer glitches result in a tidal wave of denied claims for providers? These questions still await definitive answers.
But one thing is sure: This is a burden worth assuming -- now. Healthcare providers can no longer wait for a perfect set of circumstances to move forward on ICD-10 and ICD-11, the latter of which is currently in alpha and due in 2015. Providers received nearly a decade of advance notice and have had substantial lead time to prepare. Perhaps the AMA needs to take a closer look at the gifts of ICD-10.
The Gifts of ICD-10
ICD-10 offers the healthcare industry the gift of specificity. The vagueness of previous ICD codes has curtailed precise identification of a patient's illness. Enhanced specificity will ease the process of comparing costs, quality of care, outcomes and varied protocols and diagnoses.
From a reimbursement perspective, ICD-10 will irrevocably impact the integrity of the revenue providers receive. More exact codes hope to minimize the need for complicated, confusing and often times conflicting code modifiers and edits. Specificity will bring simplicity to the process of medical coding and billing.
As time goes on, now imposing barriers will fall. ICD-10 and ICD-11 will generate multiple positive outcomes, including fewer rejected or fraudulent claims, improved understanding of procedures, more accurate payment and enhanced disease and chronic care management. The American Health Information Management Association (AHIMA), the Advisory Board and other experts concur.
New procedures that were unable to get codes under ICD-9 will get codes under ICD-10, facilitating more accurate reimbursement. ICD-10's enhanced structure, clarity and detail will curtail the number of erroneous, exaggerated claims. Providers and payers will finally have data to compare the effectiveness of procedures for specific populations, identify candidates for disease management (DM) and tailor DM programs to meet patients' needs.
Let Our Spirit Shine
ICD-10 will also allow the industry to share information and compare disease and mortality rates with multiple nations, including Australia, Canada, Sweden, France and Germany, where ICD-10 has an impressive track record and healthcare providers seem better versed in disease states, diagnoses and common protocols. The U.S. remains the only developed country to lag behind in ICD-10 implementation. When the U.S. successfully adopts and integrates ICD-10, many other nations will have already moved on to ICD-11.
ICD-10 represents a formidable challenge to the healthcare system, but so did Medicare, Medicaid, the Office of the Inspector General (OIG) and worker's compensation. The same tenacity and spirit that sustained our industry through previous periods of dramatic change will support our transition to ICD-10 and ICD-11. Even amidst providers' rush to implement EHRs and meet meaningful use requirements, ICD-10 is a necessity for all -- and worth the disruption.