Six weeks have passed since the Oct. 1 ICD-10 transition and now that the dust has settled (and no patient care organization has collapsed, to my knowledge), it’s time to talk about the bigger picture.
While the transition itself was viewed as disruptive and time-consuming at a time when healthcare organizations already were burdened with additional requirements, nevertheless, many healthcare leaders see the transition as a major milestone in the evolving transformation of our 21st century healthcare delivery system. The replacement of the ICD-9 code sets, which many viewed as obsolete, with the more modern ICD-10 ultimately results in the availability of better healthcare data, which can be leveraged, many believe, to improve patient outcomes and patient safety, lower healthcare costs and move forward with population health.
I had the opportunity to speak with Richard Averill, senior healthcare policy advisor for 3M and a member of the Coalition for ICD-10's governing board, about the long-term impact of the transition to ICD-10.
Averill sees ICD-10 as a nothing less than a fundamental and necessary building block in the ongoing transformation of healthcare delivery.
“If you think of all the things we’re trying to do – the Affordable Care Act, various attempts at value-based purchasing, measuring quality, looking at readmissions and complications – to really get at the issue of what are fair and accurate payments and what kind of quality is being provided? Those are all very ambitious endeavors and it really requires a clear and precise understanding of what was wrong with the patient, their diagnosis, their complications, co morbidities and also what was done to the patient, how were they treated and what kind of procedures did they have?” Averill says.
He points out that the ICD-9 coding set has been in use since 1979 and a “system of a bygone era.”
“Back then, you could still smoke in the patients’ rooms, there was no Internet, no personal computers,” he says. “It’s been so frustrating over the past four or five years, trying to be so ambitious in terms of what we’re trying to do and the judgments we’re trying to make and being constrained by an archaic diagnostic and procedure coding system.”
“So, as we move forward with things like value-based purchasing and accessing quality, it’s not only going to affect what institutions and individual providers are paid and perhaps ultimately their financial viability, but it’s going to affect reputations of institutions and individuals,” he says. “So in this new world that is rapidly emerging, the accuracy, detail and precision of ICD-10 is absolutely essential.”
And as many hospitals and health systems forge ahead into the population health world, the ability to effectively analyze patient care data will be crucial.
“Effective population health requires data that’s precise and detailed enough to enable adequate risk adjustment so that you can then ask ‘How well am I managing my patients and am I being paid fairly?’” he says.
“From the perspective of managing a population of patients, you also need precise, detailed data to measure quality and efficiency. ICD-10 gives you that level of detail that enables you to do that in a more fair and accurate way,” Averill says.
The implementation of ICD-10 has a number of other advantages, such as greatly improved disease management, the ability to track the efficacy of new medical technologies and devices, which had not been possible with the simplistic, four-digit codes with ICD-9, as well as the ability to detect new and emerging health threats, like Ebola. “There was no code in ICD-9 for even tracking that,” Averill says, referring to the Ebola virus and a possible outbreak in the U.S. like the one that hit West Africa in 2014.
The use of ICD-10 codes also will cut down on what he calls the “gigantic paper chase” for providers, as historically commercial payers have frequently asked for more information or additional details about a procedure when providers submit claims.
“Once ICD-10 is truly functional, we will have a more administratively simple claims processing system in terms of the interaction between payers and providers because the information that the payer or auditor needs will be contained in the code,” he says.
So, why, then, all the consternation and anxiety about the ICD-10 implementation?
“For small physicians’ offices that have had to deal with e-prescribing and the electronic medical record, it’s a lot of change in a short period of time, and then ICD-10 coming on top of that,” he says. “People want to slow down the pace of change. Unfortunately, ICD-10 should have been the first building block or the first change that was made and then the other changes should have come later.”
“I think a year from now, everyone will look back and say ‘We have a more logistical, more efficient, more fair payment system and judgments on quality than we could have had under ICD-9 and people will look back on it in a positive way,” he says.
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