Several of the organizations that represent some of the many stakeholders in the healthcare delivery system have turned up the volume against ICD-10, yet again. Some of the arguments against it are that there’s too much of a burden due to compliance work already being done on other directives and some have also exclaimed that the more fully defined code sets aren’t needed. These positions seem to just be generalities and a reaction to the challenge of change. What comes to mind when I hear such broad statements in support of maintaining the status quo is that the change is underway and we must stay the course. Think of the old sayings, “It will get worse before it gets better,” “No pain, no gain,” and so on. Any change, no matter how good the end result will be for us, always begins with difficulty and trepidation about the journey. If we can get folks to look beyond the initial worries and focus on the opportunity, we will all be better off.
Moving forward
This is not only a time of great change, but I believe we are on the cusp of an evolutionary move forward. The collective stakeholders will need to work together, contrary to stereotypes, to provide an environment in that will support, encourage and foster movement down this path of improvement. Clearly, ICD-10 won’t be easy and it impacts each major stakeholder in different ways based upon where they are in the healthcare supply chain. My greatest area of concern and nexus of ICD-10 is with the quality and quantity of clinical documentation. Clinical documentation is the primary source for the generation of a bill or claim, amongst other things. I’m aware of isolated testing efforts to create or “code” bills using the ICD-10 code set. The results show that more than 40% of the bills cannot be created due to insufficient clinical documentation. To be fair, the particular efforts referred to were in facility settings and involved both diagnosis and procedure codes. I don’t know about you, but that’s disconcerting. Not just about the potential lack of information to code claims, but what does this mean about the usability of the information that is recorded? Does this mean that documentation standards are really driven by doing no more than is required to file a claim for payment? Even then, to accomplish that requires a capable and experienced coder who’s familiar with the nuances of the caregivers in their organization. With respect to usability, how can we meaningfully exchange information across the care delivery system and establish a robust patient record that’s a reference for future care? While ICD-10 may put a spotlight on this issue, the two issues aren’t tied at the hop. There’s no reason that improvements in the creation of clinical documentation cannot begin now. If you look at the root of the generalities being made about ICD-10, it’s really about having to spend more time on creating good clinical documentation.
Collaborative approach
Beyond clinical documentation, the financial performance goals for organizations and individuals incent a focus on short-term, episodic treatment. The processes and systems we put in place mimic and support that. For the quality and cost of care to improve, and for Meaningful Use and ICD-10 to succeed, we need the stakeholders to work together and collaborate in a manner they haven’t before. This collaboration needs to result in not only appropriate pay for current services today, but in the long-term as well. The goal and focus really should be on the outcome of treatments from the perspective of the patient. To facilitate this collaboration, which clearly includes the patient, Healthcare Reform has introduced an organizational construct called an Accountable Care Organization. This can create a context in which it becomes mutually beneficial to all to provide both “reactionary” and preventive treatment and services.
If you haven’t begun thinking about ICD-10, I would suggest you start. There are analytics solutions that enable you to understand where the biggest impact to your organization will be in the move from ICD-9 to ICD-10. You can use that information to prioritize work on enhancing standards around clinical documentation for those specific protocols.
