Positive Impacts of ICD-10-CM on Patient Care

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Having a comprehensive coding system that is not “jury-rigged”, as the ICD-9-CM has become due to outdated clinical models and literally running out of codes, permits the measurement of both health outcomes and how new technologies and practice methodologies improve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”.

Posted on February 21, 2012 by Darren Carter, MD
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About Darren Carter, MD

Darren Carter, MD, founder and President of Provistas, has a personal commitment to alleviating uncertainties in the health compliance environment. He has authored dozens of articles, presents to professional and hospital associations, serves on several editorial boards, and provides consulting and expert witness testimony.
  • Susan

    Dr. Carter,
    This is an excellent article. I think we are stifled, but I also understand why they are putting the brakes on. How much do you think it is going to cost in upgrading systems et al?

    I equate the ICD 10 to that of Y 2K when everyone was scrambling to upgrade their systems or be cut off from the rest of the world of technology…With healthcare and reimbursement declining how can the multitudes of practices throughout the country find the dollars to upgrade their systems to ICD 10? I don’t believe it is because physicians and practices don’t want to utilize ICD 10 methodology, but it is a matter of costs involved.

    I understand that we need ICD 10 for evidence based medicine, but I do see both sides of the predicament.

    I would also like to know your thoughts on the best educational place to learn ICD 10?

    Thank you,

    Susan K. Vannoni, M.S., B.S., A.S., R. T. (R)(T) ROCC

    • http://www.speedecoder.com Darren Carter, MD

      Thanks for your response, Ms Vannoni.

      I think you equating the upgrades to Y2K is a perfect metaphor. Industries have to move forward! The clock was LITERALLY running out on the antiquated systems that would be disastrous for patient care and doc reimbursement. And the industry stepped up and met the challenge.

      ICD-9-CM is the same. It is not running out. It already has! The industry must move forward and INVEST. No physician practice is going to go broke making the changes they need for ICD-10-CM, a system that will likely be in place for at least a decade. Especially now, when they can piggyback ICD-10 on other electronic mandates from HIPAA 5010 to EHR meaningful use.

      These are basic capital improvements that any business owner needs to make in his or business. This is an open market system. Docs should not be shielded from having to invest in their operations to compete. This whining by physicians or by the organization purporting to represent them, the AMA, is silly, counter-productive, and anti-patient.

      I don’t know where the evidence is for your assertion that “healthcare and reimbursement [is] declining”. Medscape published an interesting survey of physician reimbursement.
      http://www.medscape.com/sites/public/physician-comp/2011

      It is nearly impossible to tease out the effects of specialty, gender, practice type, location, years in practice, age, geography, and more on the trends. However, from 2009-2010, it appears that reimbursement was just slightly higher for all docs, which sounds in line with recent low inflation. I would love more insight into physician reimbursement trends, and if you have any info, please share.

      Finally, I would simply recommend the resources at the Centers for Medicare and Medicaid Services, http://cms.gov, for learning ICD-10. They are coordinating the implementation efforts and have lots of the resources. For certified coders, they should look to their certification organizations. Physicians can also check their state and specialty associations, where I have seen lots of options. I do have an article on local educational resources on this blog, too:

      http://www.speedecoder.com/local-resources-available-for-icd-10-training/