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Doctors On Edge As Healthcare Gears Up For 70,000 Ways To Classify Ailments
HughPickens.com writes: Melinda Beck reports in the WSJ that doctors, hospitals and insurers are bracing for possible disruptions on October 1 when the U.S. health-care system switches to ICD-10, a massive new set of codes for describing illnesses and injuries that expands the way ailments are described from 14,000 to 70,000. Hospitals and physician practices have spent billions of dollars on training programs, boot camps, apps, flashcards and practice drills to prepare for the conversion, which has been postponed three times since the original date in 2011. With the move to ICD-10, the one code for suturing an artery will become 195 codes, designating every single artery, among other variables, according to OptumInsight, a unit of UnitedHealth Group Inc. A single code for a badly healed fracture could now translate to 2,595 different codes, the firm calculates. Each signals information including what bone was broken, as well as which side of the body it was on.
Propoenents says ICD-10 will help researchers better identify public-health problems, manage diseases and evaluate outcomes, and over time, will create a much more detailed body of data about patients' health—conveying a wealth of information in a single seven-digit code—and pave the way for changes in reimbursement as the nation moves toward value-based payment plans. "A clinician whose practice is filled with diabetic patients with multiple complications ought to get paid more for keeping them healthy than a clinician treating mostly cheerleaders," says Dr. Rogers. "ICD-10 will give us the precision to do that." As the changeover deadline approaches some fear a replay of the Affordable Care Act rollout debacle in 2013 that choked computer networks, delaying bills and claims for several months. Others recollect the end-of-century anxiety of Y2K, the Year 2000 computer bug that failed to materialize. "We're all hoping for the best and expecting the worst," says Sharon Ahearn. "I have built up what I call my war chest. That's to make sure we have enough working capital to see us through six to eight weeks of slow claims."
Propoenents says ICD-10 will help researchers better identify public-health problems, manage diseases and evaluate outcomes, and over time, will create a much more detailed body of data about patients' health—conveying a wealth of information in a single seven-digit code—and pave the way for changes in reimbursement as the nation moves toward value-based payment plans. "A clinician whose practice is filled with diabetic patients with multiple complications ought to get paid more for keeping them healthy than a clinician treating mostly cheerleaders," says Dr. Rogers. "ICD-10 will give us the precision to do that." As the changeover deadline approaches some fear a replay of the Affordable Care Act rollout debacle in 2013 that choked computer networks, delaying bills and claims for several months. Others recollect the end-of-century anxiety of Y2K, the Year 2000 computer bug that failed to materialize. "We're all hoping for the best and expecting the worst," says Sharon Ahearn. "I have built up what I call my war chest. That's to make sure we have enough working capital to see us through six to eight weeks of slow claims."
I used to think she was exaggerating how people specialized in not medical training, but in translating doctor's diagnosis into something the government could grok. One day about 5 years ago she brought over a binder that converted ailments to codes, I couldn't believe it. It was about 300 pages of stuff on something minor, like stitches and shots. She works for Kaiser and said they had as many coders as they had nurses, coders being people who converted diagnostics into codes for the government.
I can see how having 70k codes can track issues, but I have to wonder a) what is this going to cost; and b) how in hell do they think people making 20k/year are going to do a good job at entering codes?
I have the sneaking suspicion that this is going to backfire massively. They'll have bad data hither and yon as overworked medicos end up entering the wrong codes (hey, it's a broken femur, who cares which side?) as often as the right ones. They won't get the supposed benefits of more granular data because the data will be so screwed up that they won't be able to draw any conclusions at all.
Nothing like an industry standard to screw things up on a grand scale.
It won't backfire, it'll work perfectly.
The insurance companies sit between the doctor and the patient, view medical care as an expense, and seek to avoid paying by any means.
Having an enormously complicated system of classification gives them many more ways to deny claims, leaving the patient on the hook for the bill.
I've had personal experience with this: for a procedure which was 100% covered, the anesthesiologist put the wrong diagnosis code in his notes and the insurance company wouldn't reimburse him for that reason (but everyone else - doctors, nurses, hospital - was OK).
It took 2 1/2 years and about half a vertical inch of paperwork to straighten it out, and was a nightmare. Some tidbits:
1) The insurance company could tell the doctor that he used the wrong code, but wouldn't say what the right code was.
2) The med techs swore up and down that it was the right code (in fact, the *only* code), the insurance company stated with equal strength that it was not.
3) Since it is a mistake with either the doctor or insurance company, nothing the patient can do will help - they are completely helpless.
4) A doctor can't "just change" their notes, even when they've made a clear and unarguable mistake.
5) If you resubmit a claim, the company will deny it based on the previous denial, even if the mistake has been corrected.
#3 above is the most frustrating. The patient has to convince someone else to spend time and effort to fix something which is not their problem.
This new system is just a bureaucratic boondoggle that lets insurance companies avoid payments.
It's saying, in effect, that they care more for paperwork than they do about providing health care.
I just checked our use here in Norway and the total number of valid codes here is less than 20.000. However, there are a couple orthogonal codes bring the number of combinations way up, like in accident codes there's a code for the cause of injury (16 codes) * location (11 codes) * industry/activity (16 codes) that together is 1000+ combinations but many are non-sensical. And they are orthogonal to the medical codes describing the actual medical injury.
So multiple leg fractures would be S827, a not transported related fall injury W0n, construction area goes under "9 Other" as location as work injuries are typically classified by industry and construction industry is b, so in total "S827 W0n9b". If you sustain the same injury as a pedestrian in a road traffic accident it'd be V0n, location 1, activity usually r Other (everything but work, education, sports and exercise) so "S827 V0n1r". They usually wrap the accident codes up on a single A4 page to choose from, I've actually seen that in the ER room. And of course "Unknown" are options on both. Same thing with the medical codes, instead of multiple fractures you can code each fracture in detail using supplemental codes. It's as complicated as you want it to be.
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