Electronic Health Records

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Why ICD-10 Is More about Quality Data, Less about Payment

By Kyle Murphy, PhD

- Until recently, much of the talk about ICD-10 has centered on the obstacles preventing health systems, hospitals, and physician practices from preparing properly for Oct. 1, 2014. Moreover, concerns that the healthcare industry won’t be ready in time tend to focus exclusively on what this lack of preparation means to reimbursement.

According to Deb Neville, Director of Revenue Cycle, Coding and Compliance at Elsevier/MC Strategies, an overemphasis on the payment side of things could lead people to miss the point of ICD-10 as a coding system.

“Honestly, the big stick has always been payment. If you tie payment into something, people act,” she told EHRIntelligence.com at AHIMA 2013. “However, it’s time for us as an industry to understand that data is going to help us take care of people, the very sick; it’s going to help us manage those chronic diseases; it’s going to help us take away the risk or some of the risk to patients in the way that their care is provided.”

It isn’t that payment is unimportant — indeed, it’s crucial — but it’s that the transition to ICD-10 is also about making clinical data more useful to providers. “The problem is people don’t really understand how ICD-10 is going to help them in the future. People who have not necessarily been involved in data analytics and getting the really good data don’t understand all the benefits of data,” Neville argues.

As mentioned in an earlier story, a successful move to ICD-10 starts with creating awareness among stakeholders. Part of this awareness outreach involved communicating the fact that ICD-10 has benefits for patients in the form of providing a more accurate illustration of their health history.

“We have to somehow get across to them that it’s the information and the story they tell that’s going to help in the future be able to take care of those patients,” she continues. “That’s what the challenge is — to get people to understand why ICD-10 is a benefit, not that it’s just onerous.”

Furthermore, future decisions are based on today’s data. The quality of that data, therefore, will determine that quality of conclusions users of that data can draw. “Decisions that are made now are based on information that was generated and stored and manipulated from 2011 and 2012 so we’re behind. If we can’t get to the point where we need to be in 2014, it’s going to take years before we actually see any result of that,” adds Neville.

Without quality data, healthcare organizations and providers cannot advance the way they delivery. And it will be felt in how the patient population responds. “If you don’t have the right documentation and if you don’t have the trained people to convert that into codes, you could have a much sicker population than your peers,” Neville says.

Rather than another mandate for the healthcare industry, ICD-10 should be viewed as an opportunity for health systems, hospitals, and physician practices to prepare for what lies ahead. “Data is going to support it all. It’s going to say we care — we care enough to give you the right care today and we care enough to make sure that you get the right care in the future. And ICD-10 does that.”




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