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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."
Surely if the specification lists the data in a structured way, they don't need to be hard-coded. Can't you just stick them all in a database and do lookups? Can't the authority give that the requisite structure?
"But everyone should know everything." -markab
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.
For the most part, this isn't my problem.
ICD-10 has been on the radar for a while now. At least a couple years. And it's Federally mandated. So we didn't have any problem adding the necessary funds to our budget this year.
Each of our HIS vendors has already got ICD-10 stuff ready to go. We'll have to pay them for their time, or a software release, or whatever... But, as far as my own labor is concerned, it'll basically involve giving them remote access or throwing a disc in the drive.
Most of the labor involved is in our coding department. They're going to have to send folks out to get (re)trained in the ICD-10 stuff. They are, understandably, a little stressed. But they've been working on this for a while, too.
"Work is the curse of the drinking classes." -Oscar Wilde
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.
ICD-10 has been out for nearly 20 years. There was a 5 year timeline to get ICD-10 implemented, and there was likely a few years of discussion with major Medi* billers before that to let them know this was coming along.
Much like the FCC and HDTV, health care companies must have ignored the mandates until it was too late, whined and cried about how they couldn't meet such a strict deadline and pretty please can we extend it for another 5 years. Repeat until our health care records system is completely unusable.
Though, wow, I would have thought VistA would have ICD-10, but it's being bolted on now. Strange.
True.
As an IT guy who worked for a medical billing company I got to see the inner workings of the coding world.
It is interesting to see that it requires another human being to code from a doctors notes. And then many things came into play, such as alife medical, a EMR system that codes based off of what it reads. They even converted TIFFs with OCR so they could read it. Now with things like NextGen you can put it all into the system and let the system do it for you. No more "interpreting" what the doctor wanted to say. However, with this system it will be tough to find doctors who overbill or put in information that is untrue.
I would watch coders detect these things by finding a doctor attempting to charge for a procedure that did not even involve the issue. Can an EMR system do that? Hopefully, but it will probably be an after thought to the new coding.
And what about these certified coders? Do they have to retrain and re-certify? Probably.
That job was an eye opening experience into the Medical billing world. It was very interesting and I helped develop some of the very first medical billing methods.
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.
No. Not at all.
Coding, is just a manner of recording in a concise format, what diagnosis was made, and what treatment was given. This way the data can be used for billing and statistics.
I have never, ever seen medical codes (be them ICD9, ICD10, SNOMED) ever used by doctors, medical technologists, or anyone with any direct influence over patient care. They aren't used in X-ray equipment (so there's no risk of incorrect examinations or incorrect interpretation), blood-work analysis machines, etc.
Being an MD, and part-time software developer, I've done a lot of work with medical databases. I looked at coding of educational files, and being able to import selected educational cases directly out of the hospital's electronic record system, in anonymised fasion, into an educational system. The first thing I noticed was that the coding (in this case ICD9) was extremely inaccurate, and often wildly misleading - fewer than half the codes I looked at were correct. The reason was that the coding was done by clerical staff, who read through the charts, and worked out what codes to use. These clerical staff weren't doctors, nurses, or other people trained in medical diagnosis. As a result, they would frequently misinterpret the charts and the wrong codes would be sent to billing and for government health statistics.
As pretty much everyone else has already said, if you don't have a system that can quickly and easily update from ICD-9 to ICD-10, you're so far behind the IT implementation curve that you should be drug out into the street and shot.
It's 2011. They've had many, many years to upgrade, and now they're poised to paid by the government to do so. Hell, my employer stands to gain $50 million dollars over the next couple years from implementing key portions of the HITECH provisions in ARRA. For those reading, that's more than half of my (quite large and well-funded) health system's annual budget.
For our part, we just slapped down a couple hundred thousand for a product that hot-swaps our ICD-9 coding for ICD-10, and also tosses in a problem list that physicians can use that's tied to these coding schema, potentially improving efficiency and accuracy as well. The only excuse, and I mean ONLY excuse for ICD-10 being a problem is poor IT leadership within the health system/hospital--a failing which is incredibly, unbelievably common.
I'm lucky, I work in an IT shop that actually has its shit together.
As someone who's working with this stuff right now, I can say if it's slowing you down, you're not taking advantage of the available tools. They're out there. Keep looking. Moreover, "data entry" is one way of looking at it. A different way to call it is "documenting what they're doing with sufficient detail". That was the entire point of these kinds of standardized coding systems: to (as best as we can) remove the fuzzy documentation in the systems before, and to remove the idiosyncrasies from medical records. With the proper coding systems in place, a patient in Allentown who moves to Duluth can have his PHI moved to the new caregiver and be (for the most part) confident that the Iowans will be able to understand what the Pennsylvanians did for him before. Yeah, there's going to be transitional pain. There always is. But as has been pointed out in other posts, it's not like ICD-10 ambushed anybody. Frankly, if you haven't been moving toward ICD-10-capable systems for at least 2 years, you've been slacking. There's a penalty for that at crunch time.
Believe nothing, not even if I say it, if it violates your sense of reason -- Buddha
This is a misconception. The United States has the ighest share of private spending per individual on health care, yet it has the highest costs and only middling health outcomes.
Every system in the developed world has a private spending component, usually through insurance and copays just like here, but most also have a government payer either as the single payer or more commonly as a backstop, last resort payer; all systems more firmly regulate costs and practices and all systems at least have independent boards to assure efficacy of treatments (we call those "death panels.") There's no empirical evidence that people make rational decisions about their own health care spending.
Don't blame me, I voted for Baltar.