Tech

Does ICD-10 Pilot Forecast a Perfect Storm for Healthcare?

Let me concede from the outset that, in this blog post, I lean toward the negative—dire predictions, worst-case scenarios, a bit of doom and gloom, etc.

But I ask you, oh gentle, patient reader, how could I not?

Let’s go to the satellite. You can see warm air from a low-pressure system (Meaningful Use Stage 2, not changed dramatically by the one-year extension) collide with cool, dry air from a high-pressure area (the turmoil of Obamacare) and tropical hurricane moisture (ICD-10). Tell me you don’t see the Perfect Storm yourself.

And here we sit in our little fishing boat, waiting for the mighty ocean to consume us.

Overly dramatic? Certainly, but still not wholly inappropriate, I will argue.

Consider a recent report on the HIMSS/WEDI ICD-10 National Pilot Program collaborative that was created to, “…minimize the guess work related to ICD-10 testing and to learn best practices from early adopter organizations.”

Designed to ascertain the realities of the entire healthcare system adopting and using ICD-10, this pilot included an education and adoption program for all participants, followed by a set of “waves” in which diagnoses for the 100-200 most common medical conditions were actually coded and submitted using ICD-10.

The end-to-end testing approach …

…would encompass a number of medical test cases that mirror actual processing, including situations with multiple “hops” or “steps” between providers, clearinghouses, and health plans; the identification of high-risk medical test cases to help prioritize testing; the identification of available testing partners; and key reporting and sharing of test results. The test environment must mirror production.

And how did this pilot testing go? (Cue dark, foreboding music here …)

The average accuracy was in the 60 percent range with low scores around 30 percent.  Yes, some medical scenarios had nearly 100 percent accuracy, which is great. But very low accuracy accompanied a number of very common conditions. Not so great.


To be more specific:

  • 40%: Chest pain, unspecified
  • 33%: Closed fracture of unspecified part of femur
  • 45%: Coronary atherosclerosis of native coronary artery
  • 40%: Congestive heart failure, unspecified
  • 42%: Degeneration of the limb or lumbosacral intervertebral discs
  • 46%: Acute chronic systolic heart failure
  • 29%: Sebaceous cyst
  • 35%: Closed fracture of the intracapsular section of femur, unspecified

Predictably, the pilot identified coding-based challenges as the primary cause of low accuracy rates. Some are easily solved. Others, not so easily. You be the judge of this coding error best-of list:

  • Mixing up similar letters and numbers
  • Technical glitches with uploading and transmission of documents
  • Overworked coders
  • Incomplete EHR documentation
  • Coders forgetting key aspects of ICD-10 not present in the ICD-9 code set

Of course, all these errors require understanding the problem and tackling it within the context of process and team. If test subjects scored lower than 50 percent accuracy coding common diagnoses even after a well developed and implemented training program, what will mainstream providers achieve?  How much worse might they be?

I am speaking primarily of resource constrained provider organizations that are already on the edge financially, not Partners Healthcare or Mayo Clinic. For them, I think these pilot study figures portend a financial disaster: 50 percent coding accuracy means 50 percent claims denial and a precipitous decline in revenue. How will they make the needed changes to increase accuracy when organizations in the study could not?

According to the frank assessment offered by pilot study organizers, they will just need to focus.

The “perfect storm” will be quickly descending upon the healthcare system … All ICD-10 impacted organizations should act now to allocate as much time as possible for testing and remediation to protect their corporate bottom lines and cash flow to successfully achieve compliance.

While the pilot does not actually quantify the time and resources required for organizational change and ICD-10 compliance, a comment on the pilot offered by one physician speaks of an exhausted profession that can’t see a better day on the horizon.

As a practicing physician and using EHR (sic) for last 10 years, the last 2 with Epic both in office and hospital, I cannot image (sic) what this will mean. I now spend 11 to 15 hours a day, Monday through Friday, plus many hours on the weekend working on the computer. This ICD-10 sounds ridiculous to try to implement on top of everything else.

While I’m in partial agreement with Dr. John Halamka of Beth-Israel Deaconess and Harvard on this one, I don’t think his suggestion of a 6-month ICD-10 extension is enough. What will be so significantly different in 6 months? In that timeframe, I think the challenges that exist now—Meaningful Use Stage 2, the upheaval of the Affordable Care Act–will pretty much be the same. While I don’t expect it to happen, I’d suggest we delay ICD-10 until innovation makes it less of a burden. I can’t say when that will be, but I do have faith that it will happen.

It’s not that ICD-10 is an inherently bad idea, or that hospitals and providers can’t meet the challenge with reasonable deadlines. But they have too many challenges right now, and we are forgetting that most of healthcare is small provider organizations, regional and county hospitals and critical access facilities. If Kaiser struggles with MU, the ACA and ICD-10 all at once, what is a county hospital in Kansas or Idaho, or New York or California, supposed to do? When their reimbursement rates fall, they will face bankruptcy, and vital healthcare services will disappear from the areas that can least afford to lose them.

Yes, it is a clichéd pop-culture reference, but we truly are looking at a healthcare perfect storm like no other next year. We expect that this confluence of challenges will eliminate some health IT companies, and we generally accept that the herd needs to be thinned anyway. But can we be so sanguine about the potential impact on healthcare itself when financial ruin and simple emotional overload seem highly possible, even likely?

Providers will be driven to the brink, and I cannot see how this ends well for American healthcare, which I thought was the original goal.

Edmund Billings, MD, is chief medical officer of Medsphere Systems Corporation, the developer of the OpenVista electronic health record.

Livongo’s Post Ad Banner 728*90

51
Leave a Reply

17 Comment threads
34 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
22 Comment authors
stockimagesondemand.comsmpn1giri.sch.idpmkautobody repirChris1232 Recent comment authors
newest oldest most voted
stockimagesondemand.com
Guest

Need a banner for your marketing campaign? Purchase an extra large image and contact stockimagesondemand.com to get
it done for FREE.

smpn1giri.sch.id
Guest

I do not know whether it’s just me or if everyone else experiencing issues
with your site. It appears as though soke of tthe textt iin your
content are running off the screen. Can someone else please comment
and let mme know if thiis is happenig too them
too? This may be a issue with my browser because I’ve
had thuis happen previously. Thank you

pmk
Guest

Wow! At last I got a blog from where I be capable of in fact obtain useful information regarding
my study and knowledge.

autobody repir
Guest

I don’t know whether it’s just me or if perhaps everybody else encountering problems with your blog.
It appears like some of the text within your content are running off the screen. Can someone else please provide feedback and let me know if this is happening to them
too? This could be a problem with my browser because I’ve had this happen before.
Thank you

Perry
Guest
Perry

We are in an agricultural area, so we do get collisions with cows, horses,
sheep, etc.

archon41
Guest

Perhaps we should revert to Old School, and require providers to submit, to the people responsible for paying their fees, descriptive verbal narratives of treatment rendered, and the medical necessity thereof.

The interest of the physician in the well being of his patient is hardly the sole legitimate interest involved here. The ER physician who took care to mention the specific locus of the vehicle accident resulting in injury was perhaps aware that auto insurers, and lawyers, can be most tiresome in confirming that the treatment in question was necessitated by a particular mishap, and no other.

Perry
Guest
Perry

That’s what happens in transcribed notes, archon41, assuming someone reads them. As for EHR, as I see it, the narrative portions can be lacking, which also makes them difficult to use for cases as you mentioned above, as well as work-related injuries. In my case, I transcribe and state specifically, the patient slipped and fell on ice injuring the tailbone area, etc. This type of description is critical to establishing a cause and effect.

archon41
Guest

I assure you that the operatives to whom you send your data dread the advent of such coding as much as yourself.

I would suppose that an inordinate frequency of collisions with sea lions, turtles and skaters, at certain locations, arguably bears looking into. Not by physicians, of course.

ICD10 coder
Guest
ICD10 coder

Slipped and fell on ice injuring tailbone doesn’t have a ICD10 code. You have a number to pick from: W00 Fall due to ice and snow W00.0 Fall on same level due to ice and snow W00.0xxA Fall on same level due to ice and snow, initial encounter W00.0xxD Fall on same level due to ice and snow, subsequent encounter W00.0xxS Fall on same level due to ice and snow, sequela W00.1 Fall from stairs and steps due to ice and snow W00.1xxA Fall from stairs and steps due to ice and snow, initial encounter W00.1xxD Fall from stairs and… Read more »

Perry
Guest
Perry

That’s insane. It takes 20″ to decide there’s not a code for that injury, then what do you do?

Dr. Rick Lippin
Guest
Dr. Rick Lippin
Bobby Gladd
Guest

Well, that’s good news. We in the U.S. have 5% of the world’s population, 25% of it’s prisoners, and 50% of the world’s lawyers.

Perry
Guest
Perry

Hallelujah, that’s less that will become politicians.

Bobby Gladd
Guest

The Power of Photoshop Compels Me…

http://www.khit.org/PerfectStorm.gov.jpg

primary care doc
Guest

Fantastic! Can we forward that?

Bobby Gladd
Guest

Be my guest

Perry
Guest
Perry

Bobby, you are the man!!!

Bobby Gladd
Guest

I’ve just begun reading your latest book and will be citing/reviewing it on my REC blog (the link to which apparently remains banned here. Just
Google “REC Blog” – #1 result).

I will be citing this comment as well. Thank you.

ICD10skeptic
Guest
ICD10skeptic

Call it a mandated transfer of wealth triggered by politics, not data-driven decision-making. One could essentially boil the entire ICD-10 debate down to this: The people who have to pony up cash for the conversion and then actually use ICD-10 don’t like the idea nearly as much as those who either bear less risk or even stand to profit from the mandate. Which would be all well and good if there were known, perhaps even piloted, benefits to the broader healthcare system. Where are those? To date no one — and certainly not CMS — has clearly outlined the case… Read more »

Perry
Guest
Perry

YOYOYOY: Subdural hematoma from doctor beating head against a wall.

archon41
Guest

You’re not required to use these codes in occupational medicine, are you?

Perry
Guest
Perry

Unfortunately, the Bureau of Worker’s Compensation follows standard insurance protocols, so, yes we will probably have to start using them next year.

Nortin M Hadler MD
Guest
Nortin M Hadler MD

Dear Colleagues, I spent several years dissecting the unintended consequences of successive modifications of health policy and health financing since LBJ’s unholy compromise with the AMA that created CPTs which begot DRGs, the RUC and the like: http://uncpress.unc.edu/browse/book_detail?title_id=3262 As a result, the US entered the 21st Century with the fox in the hen house. Maybe the ACA has caused the fox to cower, for a bit. But we if we are moving US “health care” out of the hen house, it’s into the asylum. The ICD was a tool designed by epidemiologists to get some handle on the prevalence of… Read more »

Shane
Guest

We have all heard the ICD10 horror stories about systems integration issues, training, finding enough coders (good coders that is), clearing houses (remember how simple 5010′s were meant to be?). However, I do believe the greatest concern has to be with the health plans, both government and private. After all they pay the claims primarily based on the combination of CPT and ICD codes and we know how much they enjoying paying claims. Here’s an idea for the Health Plans. Create a cross walk for your plan builders and allow the new ICD10′s to link to the ICD9 in your… Read more »

Legacy Flyer
Guest
Legacy Flyer

Below are some of the more interesting ICD-10 codes: V9542XA: Spacecraft crash injuring occupant, initial encounter W5922XA: Struck by a turtle W5612XA: Struck by a sea lion, initial encounter W5609XA: Other contact with dolphin, initial encounter S30867A: Insect bite (nonvenomous) of anus, initial encounter V0001XD: Pedestrian on foot injured in collision with roller-skater, subsequent encounter. Why on earth would anyone collect this sort of information? Are we planning on doing epidemiological studies on injuries caused by marine animals? This reminds me of a story that was told by a former colleague of mine. One of the ER docs at his… Read more »

Peter1
Guest
Peter1

Obviously Legacy, if you live in Oklahoma there would be no need for those marine codes, so you would not have to use them. However in a coastal city turtles, sea lions and dolphins may be a reason for that code.

As for the roller-skater, the information could be used to ban the friggen things on sidewalks if too many incidents occur.

Dave
Guest
Dave

Peter1, I’m honestly not sure if anything you’ve written is satire or if you truly are some lefty sycophant.

Peter1
Guest
Peter1

Dave, did you look up the meaning of “sycophant” or do you just like to use it inappropriately cause it sounds smart?

Perry
Guest
Perry

I like Pedestrian on foot injured in collision with roller-skater, subsequent encounter.

Obviously the guy didn’t learn the first time to stay out of the way of a roller
skater.

userlogin
Editor

I like Consumer injured in collision with web-site, subsequent encounter

Bobby Gladd
Guest

Is there an entry for “Affluenza”?

legacyflyer
Guest
legacyflyer

Peter1,

What delusional world do you live in where you think epidemiological data would be used to make health care decisions?

The bureaucrats demand to collect the data that the politicians will not use.

Peter1
Guest
Peter1

I guess we only need one code – patient sick, I treated, send the money.

If docs don’t like the codes they can opt out and go the cash only route.

Aurthur
Guest
Aurthur

That’s ridiculous. Why require that the patient be sick? Are you suggesting that providers get stiffed when treating patients that only believe they are sick?

legacyflyer
Guest
legacyflyer

No, the coding can be brief V9542XA: Spacecraft crash injuring occupant, initial encounter W5922XA: Struck by a turtle W5612XA: Struck by a sea lion, initial encounter W5609XA: Other contact with dolphin, initial encounter S30867A: Insect bite (nonvenomous) of anus, initial encounter V0001XD: Pedestrian on foot injured in collision with roller-skater, subsequent encounter. All of the above (except the insect bite) could be coded as trauma. Whether you are struck by a space craft, sea lion, turtle or Subaru it is all trauma. Do you think it is useful to demand that auto accidents be coded for what intersection they occurred… Read more »

Peter1
Guest
Peter1

Sorry Arthur, revised code would be “a person showed up, I treated for everything, send money.

Perry
Guest
Perry

I see a disaster in the making.