Friday, February 3, 2012

Who says ICD-10 doesn't have any benefits? These guys do...

The AMA and a high-profile industry expert on the provider side recently came out against the pending ICD-10 mandate.  While this is not totally surprising and I can’t say I don’t appreciate where they are coming from, I don’t understand how these people are stating that ICD-10 will not provide any benefits.
So who said ICD-10 is without benefits?
Dr. James L. Madara, executive VP and CEO of the American Medical Association (AMA) stated the following in a letter to  John Boehner, Speaker of the House of Representatives:
   "The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patient care" See this 
A Dr. Jason D. Fodeman penned an Op-Ed piece in the Washington Post Examiner that "Congress should stop the coming medical billing fiasco.”
Dr. John D. Halamka, CIO of the Beth Israel Deaconess Medical Center and CIO and Dean for Technology at Harvard Medical School stated:
   “ICD-10 is a costly project that will have no benefits and if we're truly successful, the best we can hope for is that no one will be too upset that we implemented it.” John's article
It was John Halamka’s statement that took me by surprise.  I thought he of all people would have a more realistic and balanced understanding and viewpoint of the ICD-10 mandate.
So here’s a laundry list of “benefits” that ICD-10 will provide directly and indirectly to healthcare consumers in the United States.
ICD-9-CM is out of room. Every year, more out of sequence codes are added, which creates confusion for coders because the code isn’t where it should logically be.
Treatment techniques and methods have evolved over time. The limitation on expanding ICD-9 is the reason why few new procedures have been approved. Not all advanced treatments can be coded using ICD-9 accurately. With ICD-10-PCS, the number of procedures for which new codes are likely to be granted will rise. If many more separate procedures can be coded, a differentiation between the simple and complex procedures will be possible. <= From Code Smart News

Provider Reimbursement
Improved precision in documentation of clinical care will greatly improve the likelihood of submitting accurate claims the first time around and receiving reimbursement for a range of procedures.
Specifies procedures by degree of difficulty.  ICD-10 allows certain procedures to be subdivided by difficulty.
Fewer miscoded and rejected claims due to greater specificity in ICD-10 augers for a shorter claims payment cycle coupled with lowered administrative costs – freeing up resources for patient care improvement efforts.
Improved reimbursement rates due to appropriate payments of new procedures.
Accurate incentive payments for Pay for Performance and quality-based reimbursement programs.
Discourages up-coding and fraud.  More specificity will make it harder for providers to lump patients into a more severe disease and/or procedural category.
Care Management
Serves as the basis for implementing quality of care measurement and movement to a payment system based on quality and outcomes.
Provides improved disease and case management, as well as wellness programs.
Assists with assigning quality of care indicators and completing outcome assessments.
Tracking of healthcare-associated conditions.  ICD-10 allows much greater explanation and accountability for adverse events that occur within healthcare institutions.
Specifies reasons for patient noncompliance.  The current system offers one classification for patients who fail to follow a recommended regimen, while the ICD-10 offers at least eight.
Physicians and hospitals will have better information about their patient populations for use in quality and outcomes-focused programs. Patients who would benefit from care management programs will be better identified for those programs that can improve their health
Supplies providers with detailed information about diseases they treat.
Aligns with EHR.  The conversion to ICD-10 will ensure that electronic medical records, value-based purchasing metrics, and meaningful use incentive programs speak the same language and align with a standardized physician problem list.
Enhances utilization management by facilitating exchange of patient profile information across the care process and hospital resource management.
ICD-10 makes it easier for public health officials to track diseases and threats, dangerous settings, and even acts of bioterrorism.
Detailed data on injuries and accidents such as where they occur, what part of the body was injured, and what implements were used.
Enables enhanced public health surveillance and reporting.
Precision in reporting complications related to medical devices.  ICD-10 allows providers to be much more precise in describing the nature of the malfunction.
Support modern-day research via improved population identification & severity stratification.
Change is never easy. I understand the large demands placed on all stakeholders in today’s healthcare environment: EHR’s, meaningful use, ACO’s, HIPAA 5010, etc. But converting to ICD-10 is not without reward and will benefit healthcare all around from physicians to support personnel to payers to industry and ultimately to patients. Instead of dismissing ICD-10 out of hand and making clearly lop-sided statements that ICD-10 doesn’t provide any benefit, I would urge the AMA, healthcare providers and leading voices to acknowledge reality – if nothing else than to lend their argument against ICD-10 more credibility.


  1. ICD-10 will also force all insurance carriers to re-evaluate what is, and isn't, paid for! Since the insurance company's Profit & Loss has always been based on 'working/playing the odds', how are they to move forward with a viable business plan, if their whole "reason for being" is turned upside down?!?! I believe this is one important step towards HealthCare Reform!


    Phil Albert
    CSI Medical
    Sioux City, IA 51101

  2. Thanks for your comment Phil.

    The increased specificity ICD-10 brings will certainly open up opportunities for refining member benefit and provider contract terms - hopefully that will benefit all healthcare constituents: patients, providers and payers.


  3. The ICD-10 train has left the station and at this point everyone should be in their respective seats to include healthcare providers, payers and the government. I am concerned that the AMA will try to derail this mandate that is long over due. I worry that they fully do not understand what they are asking and those who have waited to "see" what happens may be left holding claims for millions of dollars.


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