Editor's note: This is the final installment of our yearlong ICD-10 blog series, ICD-10 In Real Time. Through the series, which was produced in collaboration with the College of Healthcare Information Management Executives, three leading CIOs shared their experiences on ICD-10 implementation, physician engagement, productivity, payer readiness and more. We'll have continuing coverage on ICD-10 implementation in H&HN Daily and H&HN throughout 2013.
I often hear it said that the use of benefit realization is not a common practice in health care. I know that this is particularly true for information technology, and I suspect it is true throughout our industry. When it comes to large-scale expenditures of resources, we usually assume that it is a necessary cost of doing business, usually in response to market-driven forces, regulatory requirements or needed upgrades in infrastructure.
ICD-10 is really no different in this regard. It is something we simply have to do, just another unfunded mandate handed down to us by our representatives in the federal government. Our friends in CMS have published a list of nine benefits, listed here in no particular order of importance or magnitude:
- Measuring the quality, safety and efficacy of care
- Designing payment systems and processing claims for reimbursement
- Conducting research, epidemiological studies, and clinical trials
- Setting health policy
- Operational and strategic planning and designing health care delivery systems
- Monitoring resource utilization
- Improving clinical, financial, and administrative performance
- Preventing and detecting health care fraud and abuse
- Tracking public concerns and assessing risks of adverse public health events
We are all spending a lot of time and resources to implement ICD-10. We are pulling personnel off the front lines of clinical care, we are maintaining duplicate systems to accommodate parallel processes for the purposes of training and assessing the impact on reimbursement, and we are spending significant funds to either upgrade or replace existing hardware and software with ICD-10 compliant versions. At the end of the day, we really have to ask ourselves, "What's in it for me?"
First of all, I don't think there is anyone who believes that ICD-10 will create revenue opportunities for providers. Most of us view it as another mechanism for payers to deny claims or otherwise slow down the payment process. If recent events are any indication, any increase in reimbursement to the providers will be viewed as likely fraudulent in nature. The recent pronouncements from Washington in regard to the use of EMRs and the increase in payments associated with that use are a prime example of that way of thinking. Personally, I believe that EMRs have enabled us to better capture the work that we're actually doing and therefore have resulted in finally being reimbursed properly with the care that we provide. If the increased specificity that ICD-10 provides does something similar, don't be surprised if we get a similar response.
Lest I be accused of being a "nattering nabob of negativism" (See Spiro Agnew, 1970), let me outline a couple of real benefits that I see from my position at an academic medical center.
Clearly, health care research will benefit. The ability to target more specifically grants and other funding for clinical research will give us new opportunities to identify and classify causes, treatments, and outcomes for a wide variety of medical conditions. In addition, we will gain significant specificity in trend and cost analysis, as well as the ability to monitor resource utilization and clinical outcomes, and address the need for value-based purchasing of clinical research.
This same increase in specificity will naturally benefit improvements in patient care. In the same way that we will be able to track utilization and outcomes for research, we will apply that same capability to monitoring and improving the kind of care that we provide and the results that we achieve for our patients. Additionally, our ability to use new technologies like genomics and proteomics in conjunction with the new granularity of information that will be required documentation to support the new ICD-10 coding schema has incredible potential to focus our efforts in treatments for a whole host of clinical conditions.
This new granularity of data will also have significant impacts on our ability to understand complications and comorbidities and will create new and more opportunities to create robust treatment algorithms. It will increase our ability to differentiate providers by performance, efficacy, outcomes and costs, which will support the value-based purchasing of medical services that we know is a part of our future. And finally, our patients will benefit by more easily understanding the coupling between their disease and their treatment.
Yes, ICD-10 can seem like more trouble than it's worth. The benefits will not be automatic, but will require additional efforts on the parts of the providers and the patients they serve to realize all of the possible benefits that could be gained. And yes, it will bring us in line with the rest of the civilized world, which is a nice to have as global citizens. So let us continue to focus on the positive aspects of the change. Expending energy on things that we cannot control doesn't add anything to any of our lives.
David L. Miller is vice chancellor and chief information officer at the University of Arkansas for Medical Sciences, an academic health sciences center.