We believe we can save health plans and self-funded employers 15% or more, and accelerate claims payments to providers from 90 days to 7 days. If you can do that, you can get the CFO of the healthcare organization to consider investing in the future, which includes all of the regulatory compliance work for ICD-10 and related initiatives.
Delaying ICD-10, AMA believes will help preserve its relevance, and its control over physician compensation. Sadly it seems that AMA hasn't served its own members well, or the healthcare industry. ICD-11 won't "arrive" in a year or two. Our health system needs to digest it and then determine when and how to move to it. While ICD-11 has some intriguing benefits, it is a long way off. The base version from WHO is expected in May 2015. After that, the United States will probably need another two years for development of the US version. The earliest it would be available for study would be 2017, and we would need another 4 years to implement it – so that brings us out to 2021, way too far in the future.
We do not support a delay in ICD-10. The delay hurts not only those who have invested dutifully to meet the CMS mandate on time, but it hurts independent contractors, small businesses, and Healthcare IT vendors who fill knowledge gap in Covered Entities who don't have the staff internally to meet this mandate.
If The Patient Protection and Affordable Care Act (PPACA) is repealed it will be interesting to see if it is repealed in whole or in part. The Supreme Court of the United States (SCOTUS) may excise the individual mandate requiring health insurance coverage, or it could strike it down entirely.
ICD-10 readiness information collected from 2,600 providers, health plans and vendors indicates that the industry would not have been ready on time for ICD-10 according to the Workgroup for Electronic Data Interchange (WEDI).
In the ICD-10 Consortium social network this week, health plans posted questions regarding processing ICD-10 claims that have date of service periods that span the mandated timeline as well as an outreach to other health plans regarding the pros and cons of receiving an ICD-10 claim, mapping it to an ICD-9 to adjudicate it. Also, ICD-10 is expected to impact auto adjudication rates for plans.
One of the key questions will be how the EMR provides a foundation with the Health Information Exchanges (HIEs) for comparative effectiveness data over the life span of a patient (sometimes called the continuum of care) and whether CDA standards currently proposed will accomplish that. Informatics people call this "longitudinal clinical data."
Look for a balanced approach between EMR vendor, other systems, and an integration strategy that is vendor neutral, enabling all impacted systems to work together to assist in the ICD-10 transition.
Health care providers should ensure that the EMR vendor is on track toward ICD-10 compliance, however they should not rely on their EMR vendor as the panacea. Most hospital systems we work with have many more ancillary systems in radiology, etc. that are also impacted, and the EMR isn't the core system of record (yet) for everything that goes on in a hospital.
Today's Wall Street Journal article on Reverse Mentoring sparked a thought. Healthcare needs reverse mentoring. RM was championed at GE by Jack Welch when he was chief executive. He ordered 500 top-level executives to reach out to people below them to learn how to use the Internet. Mr. Welch was matched with an employee in her 20s who taught him how to surf the Web. The younger mentors "got visibility," he said. For healthcare to change physicians, administrators, IT people and others should reach out to youth.
ICD-10 will re-write the book on diagnosis and procedure coding, utilization pattern history will shift. HIPPS and ICD-10 should not be viewed as separate issues for ICD-10 assessments.
ICD-10 will drive initiatives such as bundling, as a component of health care payment reform. Therefore reimbursement, and case management and other areas must be viewed in a broader landscape. HIPAA mandates and health care reform impact one another.