Is ICD-10 Implementation a Favorable Change Worth Making?
By - Are you experiencing problems with your in-laws? There’s an ICD-10 code for that. Did your water skis catch on fire again? There’s an ICD-10 code for that, too. Injured while vacationing in outer space? An ICD-10 code indeed exists.
Although stumbling upon the more unusual ICD-10 codes may initially bring about a chuckle, or three, there is a more serious gravity circulating currently regarding the alleged greater implications of ICD-10 implementation and delay within the healthcare industry come October 1, 2015. Legislative speculation abounds as differing opinions about whether or not ICD-10 is beneficial for physicians, healthcare providers, and the like mature and flourish amidst industry-wide misconception.
Continuing its steady stream of ICD-10 conversation, speculation, and advice from industry experts and leaders, RevCycleIntelligence.com recently spoke with Charles Gutteridge, MD, FRCP, FRCPath, Hermatologist, Chief Medical Informatics Officer at Barts Health (NHS) Trust, London, UK, about what might appear next around the ICD-10 bend and why such speculation matters.
“Strategy has to be about building confidence and knowledge in the clinical staff that are putting their clinical concepts into an electronic health record [EHR], which then either themselves or their related coders turn into codes,” Gutteridge states.
Although ICD-10 is a much deeper classification system than ICD-9, the basic principles of what physicians, nurses, and coders need to do are similar. The diagnostic and treatment data is richer, and more complex algorithms for developing population health become possible, he maintains. This brings forth greater industry-wide challenges.
“When doctors and coders work in a productive relationship where a doctor can test a set of codes with a coder, then you get high quality coding that is useful for population health management, and also for billing,” he states. “It's about working cooperatively and productively with vendors of software systems so that the coding products are well understood and being used well, and also understanding what the structure of ICD-10 is," he adds.
"There is a really big challenge in checking outputs to ensure that what happened to a patient has been properly described using the classification,” he explains. ICD-10’s granularity promotes flexibility, says Gutteridge. There is massive benefit for those individuals seeking reimbursement for work performed and to organizations seeking investments through insurance companies, he adds.
“Indirectly you can begin to focus the use of the classifications on where the patients are getting a good experience of care, but obviously, other data needs to feed into that. And then absolutely ensuring that the cost of individual things are matched by the coding process. Have we got the income coming in against the activity that we’re doing from a classification point of view?” he asks.
Gutteridge predicts the rejection rate of claims, currently ranging between 10 and 15 percent, “will fall very quickly as people get more used to using ICD-10.” Gutteridge says healthcare organizations settling into ICD-10 implementation come October possess the knowledge, the skill base among their staff, and systems to enter high quality claims information.
“The big effective hospitals, I suspect, won’t have claim rejections almost from day 1. It will be those organizations that have systems that are a bit less reliable, maybe staff that have been less well trained that may suffer a bit more. But I think they’ll get that together pretty quickly,” he predicts.
An implementation freeze is not a wise decision for the healthcare industry, says Gutteridge. “Freezing it is counter-intuitive and counter-productive,” he states. “I can see no argument for not making that switch towards getting better data about the healthcare needs of the population that lives in America. The medium-term to long-term benefits of being able to produce a more effective and more cost-effective healthcare system is one of the greatest needs,” he says. “You’re touching on levels of expenditure on health, which are significantly unaffordable and not sustainable in the long-term.”
Better quality data where technological possibilities abound means favorable ICD-10 change is feasible, explains Gutteridge. “In the days with really high quality information systems and data collection methods, this is not that hard,” he says, calling ICD-10 a change worth making.
