The great thing about working as a consultant is that you get to meet people from all over the country and get to hear their perspectives on “things”.  One thing I like to explore is views on the impending 5010/ICD-10 changes and conversion.  In fact I think this is one of the main things happening in the industry.   I had the opportunity to ask a couple of questions a few weeks ago to some clinical folk and I was astonished by the answers to my question.  The question – what are your thoughts on the impact of the 5010/ICD-10 to your site and the industry and how do you see it bringing US healthcare in line with the rest of the world?  Wow – what a response! First, the look on their collective faces reminded me of me when I go to the dentist and he pokes around a highly sensitive tooth or gum area with the medieval implement of torture called a dental probe.   Then the verbal response – this will never happen because CMS will not run 1,000 care delivery sites out of business and we don’t practice medicine like Europe and never will.  Needless to say I was not brave enough to pursue that line of questioning any further, but it did remind me of the mantra coined by a tremendous little brew pub in Ballard, WA – the main thing is to keep the thing the main thing.

In any case I can hide behind the relative anonymity of the pen (or keyboard) to volley back my response.  Let me take this in two parts. 

Part one – it just can’t happen.  Unfortunately it can and will happen.  Might there be a delay, unless you have a well-tuned crystal ball, you cannot say yea or nay to this.  What I think one can safely say is the change is inevitable – it will happen.  The unspoken part of the response I received is that since it can’t happen why plan?  So let’s back up just a bit - we really have a very basic binary problem it happens or not (equivalent to on or off), sort of like betting on black or red on the roulette wheel - even odds for black or red (in fact in Atlantic City, winning on black has probability of a win at 47.37%, red is identical at 47.37%, the house edge is 5.26% - but I digress).  If I were placing this bet with the institution’s fiscal viability, health and future, I’m surely betting on the change will happen since betting against the change happening could yield a stoppage in reimbursement from CMS minimally and most likely all payers.  The fiscal viability of the institution is the main thing in order to continue providing service to a community – make sure that main thing is kept the main thing.  

Another unique attribute is the shelf life of the planning.  The 5010/ICD-10 conversion plan is sort of like a Twinkie, it may get a bit dry around the edges, but it never goes completely stale or gets moldy.  If the change is delayed, minimally the planning will help a site point on a directionally correct path to meet the change, when it comes.  At its finest moment, the change comes as planned and the site is ready to go and executes the plan.  Neither scenario has too much downside and lots of upside as the planning exercise keeps the main thing the main thing – preservation of the fiscal viability and health of a care delivery institution.

Now to the next part - they need to remember that we don’t practice medicine like Europe and never will.  This statement bamboozled and befuddled me – possibly because I am not a clinician.  I had two distinct thoughts on this.

1) I know from my formal educational background in clinical informatics, that a majority of the physicians/clinicians in the United States are trained in an allopathic approach to medicine, crudely put fixing the problem once it is discovered.  Europe and other countries are more focused on preventive care.  I thought surely this cannot be the issue as ICD-10 doesn’t impact the care delivery directly, just its documentation. 

2) Could they have meant how care is paid for?  Well, again, I know that in Europe there are mixed models between “socialized” medicine like the UK and mandatory insurance like Switzerland and Germany.  I will assume this is what they meant.  So given that, will ICD-10 move us to socialized medicine, I do not think so!  Will ICD-10 mandate insurance, again no!  What ICD-10 will do is effect reimbursement for how care is paid for – a winner (in terms of what this group might have meant).  How will that happen – ICD-10 introduces the concept of laterality, which side of the body, and thereby introduces a much greater level of specificity than the currently used ICD-9 code set.  In fact ICD-9 has about 13,000 diagnostic codes and 3,000 procedure codes.  ICD-10 provides about 68,000 diagnostic codes and 87,000 procedures codes – a huge increase in specificity. So this specificity of the code set does have the potential to enable payers to adjust their overall reimbursement models downward, i.e., less money to providers.  This could yield a change in care delivery by driving a focus on preventive care since the procedures are now more complex to document and code and may receive less reimbursement.  This could be construed as a drive toward European medicine, but in this case is preventive care all that bad?

The overall point - there are good and bad points about this conversion.  ICD-10 will adjust reimbursement models, most likely downward.  ICD-10 will increase the specificity of care documentation.  ICD-10 will cause change in all corners of the care delivery system.  ICD-10 will better enable the United States to participate in global health initiatives especially those sponsored by WHO.  Most importantly the ICD-10 conversion is a CMS mandated two-step process.  First step, January 1, 2012, conversion from the current 4010A HIPAA transaction set to the 5010 HIPAA transaction set.  Step two, October 1, 2013, conversion for the current ICD-9 to ICD-10 code sets.  The main thing– delay in the change is a bet, but is it a bet a site should be willing to take.  Your call, but making the wrong call has all the potential in the world to devastate the financial viability of your organization – the main thing needed to continue to provide the much needed care for your community.  So keep the main the main thing and hedge your bets – plan for this change.

If your organization needs help remembering that the main thing is to keep the main thing the main thing, contact us at http://www.santarosaconsulting.com.  We can provide a full suite of 5010/ICD-10 services to help your organization do exactly that - keep the main thing the main.

PS Much thanks to the imaginative folks at Hale’s Ales in Ballard, WA for coming up with this blog’s title and catch phrase.