Top 3 understated aspects of ICD-10

Carl Natale
by Carl Natale

To many healthcare IT professionals the phrase ICD-10 is downright frightening. Mammoth in expanse and expense, the conversion, along with the requisite HIPAA 5010, is the stuff of Jungian nightmares, early retirement, or profound career changes.

The closer that the corresponding HIPAA 5010 and ICD-10 compliance dates get – January 1, 2012 and October 1, 2013 respectively – the clearer the picture will become as well. But with 18 months left for HIPAA 5010 and about two-and-a-half years for ICD-10, many healthcare organizations are hazy about the mandates. 

Given the complexity of both, and the fact that they are essentially best taken together, that's not at all surprising. Neither is the fact that with the deadlines ostensibly distant, there are many pieces of HIPAA 5010 and ICD-10 that, as of today, have been rather understated.

Bearing that in mind, ICD10Watch compiled such a list.

1 Better patient care
The overarching and ultimate promise of ICD-10, yet one aspect that even this ICD-10-obsessed writer hears little about, is how it will improve patient care on scales both individual and international. 

“If ICD-10 is utilized appropriately as it is in the rest of the world, the output is much more reliable information on outcomes,” says Jim Dugan, partner, PricewaterhouseCoopers. “Everyone would agree that having more detailed information could only help the research population in regards to looking at clinical trials. Certainly, looking at overall utilization of services that come out through the system is another added benefit of ICD-10.”

More granular codes, it follows, can be better analyzed to study health trends and yield more positive outcomes.

“The new code set will link the U.S. to all other industrialized countries identifying and managing health threats and outbreaks,” explains Tori Sullivan, a manager in Capgemini's healthcare division who also chairs HIMSS ICD-10 Task Force. “Most importantly, ICD-10 enables us to more quickly identify and resolve coding errors, thus improving the submitted data. The quality of our healthcare has the opportunity to improve as a result of ICD-10 data, improving both individual and national healthcare quality.”

2 The benefits of HIPAA 5010
Commonly viewed as a pesky EDI pre-cursor to ICD-10, the forthcoming HIPAA 5010 actually brings some 500 enhancements over 4010 and an overflowing handful of benefits, though these are currently poorly understood.

Even the folks at CMS (The Centers for Medicare and Medicaid Services) basically buried its list of HIPAA 5010's advantages during the last National Provider Conference Call on the subject. Highlighting 7 benefits of HIPAA 5010 required CMS to be broad, as in “supports e-health initiatives now and in the future” and to be very specific, “provides infrastructure on ICD-10 and Present on Admission Indicator.” Others include: less ambiguity in the implementation guides, improved utility of the NCPDP standards, compliance with Part D requirements, and supports standardization of companion guides across the industry.

HIPAA 5010 will “offer consistency of processing for payers and clearinghouses,” that 4010 does not, Christine Stahlecker, CMS director of medical billing procedures, said during the provider conference call.

3 The possibility of “Minimum Compliance”

PricewaterhouseCoopers' Dugan says “the thing that I’ve not heard too many people talk about is the various ways of looking at ICD-10 from a minimum compliance perspective.”

Think of this as an approach in which healthcare organizations meet the mandate first, as required by law, then reap rewards later as doing so becomes strategic to heir business. How much later? That all depends. As does the nationwide effectiveness of ICD-10. “The question is: Will the provider community embrace that day one, or is that something that’s really not October 2013 but could be October 2016? And there’s a further migration strategy there,” Dugan adds.

Any possibility of minimum compliance is fast becoming a probability. Indeed, Deloitte in May said that, among its clients, the payers who were amid a move from ICD-10 assessment and into remediation found the task so much more challenging and expensive that they are adjusting their expectation from innovative to merely pragmatic, meaning they plan to adhere to minimum compliance, at least initially.

The downside to the legal bare minimum? “The longer it persists where we are taking a minimal approach, then you’re limiting the information you have available to you and it’s going to take that much longer to get some of the benefits where you can set best practices or compare doctors more easily,” says Cathy Veum, senior manager with Noblis health innovation unit. “Those things will come down the pike, but the more quickly you have the robust data the sooner that’s going to happen. If we drag this on and take the minimal approach it’s going to be many more years.”

Those are just three of the understated aspects of ICD-10. What others have you found?