Yesterday, Dr. Jason D. Fodeman penned an Op-Ed piece in the Washington Post Examiner that “Congress should stop the coming medical billing fiasco” where he opined that the coming conversion to ICD-10 will do more harm than good. I can hardly disagree more with Dr. Fodeman.
In this post, I present a few questions and comments to Dr. Fodeman. I’ll present these questions and comments in the order by which Dr. Fodeman presented his viewpoint; and that’s all this post and Dr. Fodeman’s Op-Ed really is…a viewpoint, however biased we each might be. :)
Q1: Where’s the evidence that ICD-10 ‘regulations will do more harm than good?”
C1: In fact, ICD-10’s increased specificity will mitigate the need for providers (professionals and institutions) to submit additional information. I noted these clinical data elements in a post a short while ago. See Computer-assisted coding for ICD-10
C2: There are some silly and likely unneccesary codes in the new ICD version. They’ve made for some amusing articles and posts. I believe this WSJ article started the laughs Walked Into a Lamppost? Hurt While Crocheting? Help Is on the Way and went a long way toward exposing some of ICD-10's silliness. But how many providers and payers actually believe they’ll be required to submit codes for these silly conditions?
C3: No doubt that converting to ICD-10 is a non-trivial cost – for professionals, facilities, payers AND intermediaries. And these costs will be a drop in the bucket compared to the benefits that greatly enhanced care management, administrative efficiencies, benefit design, provider reimbursement, compartive effectiveness research and other improvements ICD-10’s specificity will enable.
C4: Not converting to ICD-10 epitomize the problems facing our nation's healthcare system: fractured care management programs, administrative inefficiencies, unrealistic benefit packages, inaccurate provider reimbursement levels and the inability to perform meaningful compartive effectiveness research. Moreover, the pay-for-performance and quality management programs needed to really make an impact to our healthcare are enabled by ICD-10.
C5: All healthcare constituents have a stake in improving healthcare outcomes in the United States: patients, physicians, hospitals, payers and intermediaries. It seems self-serving for physicians to be leading the charge against ICD-10 with the somewhat aggressive stance that they are the only ones that will not benefit from ICD-10's modern age diagnoses coding capabilities.
Q2: What is the reason that providers are not already capturing and documenting the information necessary to properly code a complete diagnosis? If not, I suggest they are largely committing malpractice. I had an Aircraft & Powerplant license and a good mechanic would never think of not over-documenting the work they did – it was just good business sense - for the mechanic, the pilot and the passengers.
C6: I totally disagree that the ICD-10 mandate ‘will be onerous and frustrating for physicians” and that it’ll be "the patients that suffer the most from diminished care.” How could more accurate, detailed clinical documents, enhanced adjudication/payment processes, and the abilty to develop new procedures and care management programs via comparative effectiveness programs – all of which will be enabled by ICD-10 – diminish pateint care?
C7: I agree with Dr. Fodeman that CMS got the cart in front of the horse. ICD-10 and HIPAA 5010 compliance should have been mandated before Meaningful Use. But I suppose they thought hanging the MU carrot out before the ICD-10/5010 stick would be more palatable. Sort of like building the master bath and bedroom of a house before laying its foundation?
In closing, I’ll say once again – like Dr. Fodeman did in his closing paragraph – one can joke all they want about ICD-10 codes for being "bitten by turtle" and "struck by turtle" - or, my personal favorite - "sucked into a jet engine, for the second time" - but that tack, to me, is a red herring attempting to diminish the true and real value implementing ICD-10 diagnosis coding offers the U.S. healthcare system.