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Federally-Mandated Medical Coding Gums Up IT Ops
Lucas123 writes "The change over from a medical coding system in use since the 1970s to an updated version that adds more than 50,000 new 7-character codes is being compared to Y2K as an IT project that is nearly impossible to complete on time. ICD-10, which replaces ICD-9, adds far more granularity to medical diagnosis and treatment. For example, ICD-9 has one code for a finger amputation. In contrast, ICD-10 has a code for every finger and every section of every finger. An 'unfunded mandate,' the change over to ICD-10 codes is a multi-year project for hospitals, state Medicaid organizations, and insurance providers. The effort, which affects dozens of core systems, is taxing IT operational budgets at a time when shops are already under the gun to implement electronic health records."
While this is definitely a huge pain, I have little sympathy for those complaining about the timing of this when the standard was finalized in 1992.
The misattribution of the reason for rising costs in health care is unfortunate. The fact that government as a payor is in this system is one of the main reasons costs rise as such a rate.
I work on the revenue side at a fairly large health system, and due to our population we have approximately 50% of our patients privately insured, and close to 50% are government insured. (There are very few people coming in the doors who truly have no coverage, despite what the politicians would have you believe). The privately insured generally repay approximately what's billed, but for the government paid accounts, we would do well to recover 50%, 40% is a better guess. This is because the government solves its own budgetary problems by withholding increases to its medical payouts. In this area, we're still being paid at 2002 rates in 2011. We never withhold a needed service, so we just eat the cost.
But we have to make the books balance somehow. We're non-profit, but we still have to keep the lights on. Charge rates have to go up across the board, and the money lost on literally every government paid patient who walks in the door is then made up by the privately insured. You hear about $8 tylenol being billed, well, tylenol has to cost $8 because you're actually buying a whole bottle and sharing it with everyone else.
I think we're going to continue to have a huge gap of misunderstanding while people continue to emote over "big business" and "fat cats" and "obscene profits" without understanding what the real financial issues are on the ground.
Posted as AC due to PHB concerns.