ICD-10 presents opportunity for more detailed information, better health care
As of Oct. 1, 2015, every health care provider will be required to use the 10th revision of the International Statistical Classification of Diseases and Related Health Problems.
The proposed benefits of ICD-10 include more detailed information on clinical and surgical conditions and better measurements of the overall value of health care services. ICD-10 also will provide the ability to compare differences within regions of the United States and with international data. The information may help improve clinical and surgical practice guidelines across the entire spectrum of health care services, including musculoskeletal care.
Without question, ICD-10 is a complex system that requires technological advancements with our practice management systems. However, technology is not driving the innovation. The innovation is driven by the desire to have more information to define what is truly valuable to patients. In the current environment of increasing health care costs, combined with wide variations in practice patterns and unexplainable variations in nontransparent charges, we need more comprehensive data to establish a better framework for value-based health care.
Anthony A. Romeo
As the ICD-10 system has more than 140,000 possible codes, it is critical orthopedic surgeons prepare for and lead the conversion as it will affect every aspect of their professional lives and the practice overall. Among the concerns is how ICD-10 will affect revenue cycles and allow practices to continue if substantial reimbursement issues last up to 6 months or longer. It may be necessary for a surgeon to secure a line of credit to be prepared for financial stress during the conversion period.
Having a passive non-invested approach or allowing hospital or practice administration to take full responsibility for the conversion likely will handicap a surgeon’s ability to accurately document patient care. If the work provided by each surgeon cannot be documented accurately, then the role of each physician will be blended into a collective service line. This process may be acceptable to some physicians, but they should understand that the lack of active involvement in the documentation of services and care furthers the effort to commoditize physicians and physician-provided care.
Demonstrate value of care
Hospitals and health care systems have been aggressively preparing for ICD-10 by ensuring documentation is thorough and complete. We need to do the same. Our ability to be fairly compensated for the services we provide will be directly impacted by the conversion to ICD-10 for many reasons, including that not all third-party payers will be ready to process claims by Oct. 1.
Training is essential to understand new options available to code diagnoses and symptoms for which care is provided. Physicians should work with coding and billing experts to perform chart reviews, and then convert codes from ICD-9 to ICD-10. Starting with the top 10 to 20 diagnosis codes allows a practical training method to prepare for the transition. More important than ever is the ability to recognize and document medical and social comorbidities that affect outcomes, such as smoking, diabetes, obesity, osteoporosis, opioid use and previous failed surgical management. The documentation will improve the data for better decision-making and the value of care and reimbursement.
With the continued acceptance of high-deductible health care plans, patients are more involved in how they pay for services. Patients want clear indications about the value of health care expenditures. Proper documentation and better price transparency are essential to demonstrate value and cost-effectiveness.
Improve clinical documentation
The conversion to ICD-10 can provide the motivation to reassess and improve the clinical documentation process. In addition to including mandated information and demographics, there is added value in incorporating questions to provide clearer descriptions of outcomes from patients’ perspectives. An assessment of the practice’s electronic medical record is essential to not only understand its ability to comply with ICD-10 coding, but also provide the resources to help physicians and staff with the changes ahead.
While the focus will often be related to information technology, physicians should use this paradigm shift to carefully look at the entire process and provide a more accurate assessment of the services provided. The front office should demonstrate the ability to establish a positive relationship with patients and provide information that explains and facilitates the collection of funds directly from patients. Orthopedic surgeons and staff should be capable of using ICD-10 codes that document appropriate diagnoses for all services provided, including ancillary services. In the back office, orthopedic surgeons should have the ability to work with the billing staff to understand collection percentages, denials and days in account receivable.
Better insight to come
Patients, physicians, researchers and third-party payers are looking for more information to have better insight into the benefits of health care. This includes more accurate and in-depth information about disease processes and how health and wellness prevent medical issues. Searching for information underscores the lack of clear medical care guidelines and best practice recommendations for many common conditions physicians routinely make decisions about based on personal experience or expert opinion, as opposed to higher levels of evidence.
ICD-10 will be a challenge to integrate into our every day practice. However, the time has come to embrace the potential of having more detailed information to provide better health care. We have an opportunity to achieve more patient involvement, which is likely to provide better outcomes for many common medical and surgical problems. In orthopedics, we can get more answers and better evidence about the best nonsurgical and surgical treatments for the most common conditions. The information will provide clearer guidelines for population health management and the prevention of orthopedic problems.
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- Anthony A. Romeo, MD, is the Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Rd., Thorofare, NJ 08086; email: firstname.lastname@example.org.
Disclosures: Romeo reports he receives royalties, is on the speakers bureau and is a consultant for Arthrex; does contracted research for Arthrex and DJO Surgical; receives institutional grants from AANA and MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Miomed.