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Com Pro Med Stands Out: An ICD-10 Overview

As we all know, October 1st was the deadline for one of the biggest shakeups in recent years within the industry; that of the ICD-10 coding system. It’s been less than a few months in, and a cursory look at how its implementation is being reported varies. Some are optimistic, insisting that they had expectations for a much tougher transition, but they have been pleasantly surprised. Others are noting recent statistics that point to big problems. How well prepared has CMS been for the transition? And how big a difference is reality from the expectations for ICD-10, which has been touted as the ultimate drive for efficiency?

ICD-10 has brought with it a multitude of hurdles for the medical community to overcome. Comp Pro Med as been at the forefront of this re-organization by offering its services to help its clients at no cost in navigating the new ICD-10 code system. Whereas many other companies have been quick to develop high-price specialized tookits and packages promoting a swift guide to ICD-10 preparedness, Comp Pro Med has stood its ground by offering to convert data free of charge to its loyal customer base. We believe at Comp Pro Med that loyalty deserves respect. We value our clients, and we believe that our actions speak for that.

There has been extravagant cost, manpower, and training invested in implementing the coding system which was sold as a way of “catching up with the rest of the world”. Despite the rosy scenarios painted by some that everything is fine with the transition, there have been significant bumps and burdens that attest that just the opposite is true.

When CMS updated its ICD-10 FAQs, the answer it gave to “What are the Benefits of ICD-10?” were as follows, in nine bullet points.

1 Measuring the quality, safety and efficacy of care
2 Designing payment systems and processing claims for reimbursement
3 Conducting research, epidemiological studies, and clinical trials
4 Setting health policy
5 Operational and strategic planning and designing healthcare delivery systems
6 Monitoring resource utilization
7 Improving clinical, financial, and administrative performance
8 Preventing and detecting healthcare fraud and abuse
9 Tracking public concerns and assessing risks of adverse public health events

 

In other words, we were told to expect bright things. WHO described it as a “system of diagnostic codes established for defining and reporting disease, identifying global health trends and collecting global statistics, and providing a common language for health information distribution.”

A global coding system for hospitals which would be high on benefits to research, and make information generally easier to process is a noble intention. Who doesn’t like compiling research for the greater good? Not to mention preventing fraud and trying to plan healthcare efficiently with cost-saving tactics. We would all like to see the healthcare industry make room for improvements which benefit everyone. But unfortunately, the logistics of these points, in particular number 2, are ideals whose reality is currently proving to be a greater challenge.

Many physicians have warned the danger of rushing into the ICD-10 program. Earlier this year 100 medical societies, which included the American Medical Association (AMA), banded together to warn the public of the problems that ICD-10 could bring.

The chief warnings across the board have concerned both what the rate of CMS claim rejections would be under an ICD-10 full transition, and the drop in productivity that would occur under such a scenario. Those fears are now turning out to be more than well founded.

ICD-10 has turned out to be a juggernaut of bureaucratic denials. Instead of just being a drop in the bucket, someone dropped a big rock in, and now the splash is definitely being felt. After reimbursement claims are received, the insurers can approve and pay them, or deny them. This typically includes a reason given. Incorrect diagnostic codes are already cited, and even though providers can appeal a claim denial, it adds significant financial and administrative burdens on those practices. And it’s getting higher.

In other words, the fear has been this would overly complicate and burden an already burdened system. CMS typically accepts 95 to 99% of all claims. But the percentage of rejected claims since Oct 1st has been a whopping 10%. CMS reports that only 2% of those claims were due to incomplete or invalid information. When you add to this the assurance CMS gave earlier this year that it would not deny any claims during the first year of ICD-10’s implementation based on incorrect diagnosis codes, questions begin to arise. This well-orchestrated chaos is most likely not registered in the quarters of academic research that thrive merely on statistical analysis and collection, but for the people whose claims are being denied, this can hardly be a comfort.

ICD-10 was sold on several premises. But the explanations that supporters have to justify its implementation are often not as strong as the arguments against it. The ICD-9 system is 35 years old now and one of the arguments for adopting ICD-10 was that much of the rest of the world is already doing it, and that we should all be on the same page. All being a surprisingly loose term, though, seeing as how most of WHO countries using ICD-10 only use it for recording mortality (138 of them) or morbidity (99 countries). A whopping total of 10 of these countries use ICD-10 for reimbursement claims and 6 of those have single payer health care systems, who are not subjected to go through the entanglements of private insurance. And ICD-10 may be a more recent upgrade of ICD-9 but it is often shockingly out of date. For instance, as John Elion MD, an associate professor of medicine at Brown University points out,

“There are pages of tuberculosis codes, but there’s only one HIV code. It hasn’t kept up with modern diagnoses and procedures — it’s just grossly out-of-date.”

He goes on to say:
“The explosion in number of codes is highly overrated. [The new code sets] are all things we keep track of. Many of the new codes are due to having to specify whether something is on the left or the right. Coders have more to worry about, but it’s not that many new medical concepts.”

ICD-10 has essentially asked medical practices to increase that number of diagnostic codes from 14,000 to 68,000 separate codes. This influx has been marketed as being the next step that doctors need but codes have nothing to do with doctors being able to make a diagnosis. Doctors don’t treat according to a diagnostic code, but according to clinical situations. Data retrieval on a statistical mass level is going to be easier, but how does that translate into better patient treatment when billing takes longer?

When looking into why ICD-10 has been put into place, one must be able to read between the lines. Here’s a very telling quote from a vocal supporter, Carmella Bocchino, the executive vice president of America’s Health Insurance Plans (AHIP), who says ICD-10 will:

“enhance the ability to measure and improve health care services; support disease management programs; enhance the ability to conduct public health surveillance; compare data with other countries; and support a 21st-century health system.”

Research is one thing, but reimbursement is quite another. A month after ICD-10 was put in place, Himagine released a report after surveying 140 health care providers. They found that respondents predicted before implementation the productivity effect from ICD-10 would be at least 30%. In a recent survey for Healthcare Infomatics, the following was found:

  • Large hospitals reported a 30% to 45% reduction in inpatient productivity and a 20% to 40% reduction in outpatient productivity;
  • Large academic medical centers reported a 40% reduction in inpatient productivity and a 10% to 35% reduction in outpatient productivity; and
  • Community hospitals with fewer than 250 beds reported a 22% to 33% reduction in inpatient productivity and a 35% to 40% decline in outpatient productivity (Healthcare Informatics, 11/10)

These are not the most welcome statistics for proponents. Who is benefitting from this? The numbers simply don’t lie.

Just how much does all this add up to? In 2008 and 2014, the AMA commissioned two studies from Nachimson Advisors. The second study cited that in “some cases, estimated ICD-10 implementation costs were nearly three times what had been predicted in 2008. It found the following cost ranges for each practice size based on variable factors such as specialty, vendor and software:

  • Small practice        $ 56,639 to $ 226,105
  • Medium practice   $ 213,364 to $824,735
  • Large practice        $ 2,017,151 to $8,018,364”

All of this is for a system whose biggest claim to usefulness is data collection. Patients and doctors alike are being thrown into a bureaucratic maelstrom, and they are both paying the price. ICD-10 has been making the rounds for years as extensions allowed for stalling or talking about the inevitable. That the actual use of this coding system is unnecessary to the overall well being for patient health care in the U.S., and the exorbitant amounts of money spent ensuring its survival could have been much better spent in alternate outlets.