Since the Department of Health and Human Services has announced that it plans on delaying the implementation of ICD-10 largely, if not entirely, due to the American Medical Association’s inability to support its membership in a critically important update to our health information infrastructure, it is a good time to review the positive impacts of ICD-10-CM on patient care. The goal of the new coding system was not to confuse physicians but is rooted in achieving long standing goals of public health.
Having a comprehensive coding system that is not “jury-rigged”, as the ICD-9-CM has become due to outdated clinical models and literally running out of codes, permits the measurement of both health outcomes and how new technologies and practice methodologies improve them. The new coding system also helps us to compare ourselves to the rest of the world, which is using some form of ICD-10. This can be critical when tracking disease outbreaks across the world as well as determining the overall effectiveness of healthcare on a population basis.
One particular example is the diabetic codes. There has been a major overhaul in these codes, capturing the etiologies and sequelae of the disease more clearly. Now it is possible to see the progression or non-progression of the disease and how different treatments might improve outcomes.
Outcomes are a critical part of this new more detailed system and help to establish better performance outcomes in pay-for-performance (P4P, pay-for-quality, P4Q) reimbursement. The goal of these reimbursement systems is to have physicians or accountable care organizations (ACOs) earn additional reimbursement based on their adherence to established best clinical practices for particular conditions, such as diabetic care management. Research seems to indicate that these programs can both improve outcomes while reducing costs but continued efforts are required to establish the best P4P components.
Wendy Whittlington, MD, MMM sums up the concerns about being stuck with ICD-9-CM for any more time very well:
How long are we willing to use a coding system that doesn’t work for us and that prevents us moving forward with meaningful comparative effectiveness research and ultimately evidence based medicine? The decision to put off ICD-10 is a setback in modernizing our healthcare system and brings more uncertainty into an already chaotic environment.
Our strong hope is that HHS does not delay ICD-10-CM/PCS for more than one year for the health of our nation since it has already caved to pressure from an organization whose mission is supposedly “the betterment of public health”.