Survey about delaying the transition to ICD-10 for more than two years: many say “catastrophic”

The fallout from the announcement continues…look at the results from this survey!

“Bellevue, Wash.-based health IT vendor Edifecs surveyed 50 healthcare professionals representing payors, providers, government and other stakeholders at its February ICD-10 summit and published the results in a Feb. 27 white paper.

There was less consensus regarding the effects of a one-year delay compared with a two-year delay, indicating a majority believe that the longer the delay, the more negative its consequences.

The vast majority (90 percent) of respondents believed that the deadline should not be moved more than a year. Questioned about a one-year delay, 58 percent of respondents said it would be “costly, but manageable” compared to 37 percent who said it would be “beneficial.” Questioned about a two-year delay, 56 percent said it would be “potentially catastrophic,” 22 percent said it would be “costly, but manageable” and only 4 percent said it would be “beneficial.”

While moving the deadline provides organizations with more time to comply, researchers indicated that the major concern with a delay is cost. Many organizations have contracted with consultants or hired employees specifically for the transition to ICD-10 and will now have to decide whether they will continue setting aside funds for those positions or if they will be cut, researchers wrote. More than 70 percent of respondents said they believed that the Centers for Medicare & Medicaid Services (CMS) should reimburse organizations for the delay, 49 percent predicted an 11 percent to 25 percent increase in total ICD-10 transition budgets for each year of delay and 37 percent predicted a 26 percent to 50 percent increase in total ICD-10 budgets for each year of delay.

The uncertainty surrounding a new timeline for implementation is currently most stressful for healthcare organizations, according to researchers, who suggested that quickly completing an evaluation should be the top priority for the CMS.

“The United States spends more on health care than any of the other OECD countries…”

Ezra Klein is skating to where the puck is….

“In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978. If we had the per-person costs of any of those countries, America’s deficits would vanish. Workers would have much more money in their pockets. Our economy would grow more quickly, as our exports would be more competitive.

There are many possible explanations for why Americans pay so much more. It could be that we’re sicker. Or that we go to the doctor more frequently. But health researchers have largely discarded these theories. As Gerard Anderson, Uwe Reinhardt, Peter Hussey and Varduhi Petrosyan put it in the title of their influential 2003 study on international health-care costs, “it’s the prices, stupid.”

As it’s difficult to get good data on prices, that paper blamed prices largely by eliminating the other possible culprits. They authors considered, for instance, the idea that Americans were simply using more health-care services, but on close inspection, found that Americans don’t see the doctor more often or stay longer in the hospital than residents of other countries. Quite the opposite, actually. We spend less time in the hospital than Germans and see the doctor less often than the Canadians.

“The United States spends more on health care than any of the other OECD countries spend, without providing more services than the other countries do,” they concluded. “This suggests that the difference in spending is mostly attributable to higher prices of goods and services.”

On Friday, the International Federation of Health Plans — a global insurance trade association that includes more than 100 insurers in 25 countries — released more direct evidence. It surveyed its members on the prices paid for 23 medical services and products in different countries, asking after everything from a routine doctor’s visit to a dose of Lipitor to coronary bypass surgery. And in 22 of 23 cases, Americans are paying higher prices than residents of other developed countries. Usually, we’re paying quite a bit more. The exception is cataract surgery, which appears to be costlier in Switzerland, though cheaper everywhere else.

Prices don’t explain all of the difference between America and other countries. But they do explain a big chunk of it. The question, of course, is why Americans pay such high prices — and why we haven’t done anything about it.

“Other countries negotiate very aggressively with the providers and set rates that are much lower than we do,” Anderson says. They do this in one of two ways. In countries such as Canada and Britain, prices are set by the government. In others, such as Germany and Japan, they’re set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail.

In America, Medicare and Medicaid negotiate prices on behalf of their tens of millions of members and, not coincidentally, purchase care at a substantial markdown from the commercial average. But outside that, it’s a free-for-all. Providers largely charge what they can get away with, often offering different prices to different insurers, and an even higher price to the uninsured.

Health care is an unusual product in that it is difficult, and sometimes impossible, for the customer to say “no.”

Shocked, but not surprised: HHS announces intent to delay ICD-10 compliance date

Who could possibly have seen this coming? Oh, wait.

Some chatter on this at: http://www.icd10watch.com/blog/we-still-have-icd-10-implementation-plan

Over at DotMed, here is some scuttlebutt:

How long the delay would be for isn’t known. Still, the news drew praise from the AMA, which formally announced its opposition to the October 2013 ICD-10 deadline in a meeting last November.

“The timing of the ICD-10 transition could not be worse for physicians,” Dr. Peter Carmel, AMA’s president, said on the group’s website this week. “Burdens on physician practices need to be reduced — not created — as the nation’s health care system undertakes significant payment and delivery reforms.”

In defense of the current deadline, HIMSS said many of the “larger providers” have already taken steps necessary to put ICD-10 in place in time. In fact, HIMSS said 90 percent of 302 health care IT executives responding to its recent leadership survey said they would meet the original deadline, according to a study the group intends to share next week at its annual conference in Las Vegas. HIMSS also said 67 percent of respondents to the survey said ICD-10 implementation is their number one financial IT priority.

“While HIMSS understands and recognizes that there are providers facing resource challenges to meet the compliance date, the conversion to ICD-10 code sets will affect more positive outcomes for patients,” the group said in its announcement.

Of course, ICD-10 isn’t the final stop on the line. As America braces for ICD-10, ICD-11 is already in the works.

The actual writ from HHS:

HHS announces intent to delay ICD-10 compliance date

As part of President Obama’s commitment to reducing regulatory burden, Health and Human Services Secretary Kathleen G. Sebelius today announced that HHS will initiate a process to postpone the date by which certain health care entities have to comply with International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).

The final rule adopting ICD-10 as a standard was published in January 2009 and set a compliance date of October 1, 2013 – a delay of two years from the compliance date initially specified in the 2008 proposed rule. HHS will announce a new compliance date moving forward.

“ICD-10 codes are important to many positive improvements in our health care system,” said HHS Secretary Kathleen Sebelius. “We have heard from many in the provider community who have concerns about the administrative burdens they face in the years ahead. We are committing to work with the provider community to reexamine the pace at which HHS and the nation implement these important improvements to our health care system.”

ICD-10 codes provide more robust and specific data that will help improve patient care and enable the exchange of our health care data with that of the rest of the world that has long been using ICD-10. Entities covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) will be required to use the ICD-10 diagnostic and procedure codes.

To-do list for the ICD-10 changeover on Oct. 1, 2013

The gossip I am hearing is making it sound like way too many hospitals are flat-out not prepared for the changeover. The added cost of the transition will hit some who are cash-strapped hard. Nonetheless, I maintain that clinicians need the extra flexibility in the expanded codes so as to represent the particular aspects of individual patient medical conditions. I did some research for my dissertation on mapping ICD-9 to ICD-10 codes for palpitations and arrhythmias, and it looked reasonably straightforward. But I wonder about diseases like autism, which the DSM-V will handle rather differently.

I found this list of to-do issues from Rhonda Buckholtz on http://www.beckersasc.com:

Start anatomy and physiology training for coders: coders should be focusing on anatomy and physiology training to make sure they can code to the level of specificity required by ICD-10. Once the ICD-10 implementation date rolls around, coders will be in short supply and you want to build loyalty before then.

Start training physicians on documentation. “ICD-10 has a much higher level of specificity, and some of the concepts found in ICD-10 weren’t found in ICD-9.”…about 35 percent of the time, the coder is unable to assign an ICD-10 code based on physician documentation.” If physicians are hesitant to start documentation training, emphasize that if their claims do not get paid, they will be living on 65 percent of their previous revenue.

Talk to your vendors about their transition plans. Some vendors may even choose not to make the transition to ICD-10 — an issue you need to know about as soon as possible. “You don’t want to be left hostage at the last minute, finding out your vendor is not going to make the transition,” she says. You may also find the vendor offers the software upgrades for free, but you don’t have the hardware to accommodate it. Find out your areas of need now so you can budget for any necessary purchases over the next few years.

Talk to commercial payors about their transition plans. Check with your commercial payors immediately to find out how they’re making the transition to ICD-10. You need to know whether they are going to make changes to policies and payments so you can adjust your processes and reimbursement expectations to match.

Follow the “day in the life” of a diagnosis code. There are many ASC policies, procedures and software products that will be affected by the transition to ICD-10 — in fact, every piece of paper or program that contains diagnosis codes. To make sure you don’t miss any areas that will be affected, go through the “day in the life” of a diagnosis code at your facility, from the first time the surgery center calls the patient to the last check-in after discharge.

“Go through and do the physical inventory to find out where the diagnosis code is tied into your center,” Ms. Buckholtz says. Ask your staff members to help you in this process; chances are, your business office manager and receptionists will know where diagnosis codes live in your center and how they affect your operations.

Determine which policies and procedures will be affected by ICD-10. Some policies and procedures will be affected by the transition to ICD-10, especially those that require diagnosis codes on forms, Ms. Buckholtz says. For example, every time a surgery center provides a service for a Medicare beneficiary, the staff has to provide an advanced beneficiary notification. If your surgery center has made customized ABN forms for this process, you will need to adjust the code fields to fit with ICD-10.

Survey: only 22% of health insurers are fully prepared to support ICD-10

from Information Week Healthcare:

“Only 22% said they were fully prepared to support ICD-10, with remediation plans in place and system upgrades underway. About 37% indicated that they were “somewhat prepared,” but not sure that they would be able to meet the deadline, while 36% were just starting to ready themselves for ICD-10. Just over 5% have not finished evaluating their IT capabilities or created a remediation plan for the new coding system.

“This is not terribly surprising,” HealthEdge executive VP Ray Desrochers, told InformationWeek Healthcare. “A lot of the largest payers got their act together early,” Desrochers said, but noted that the tier just below the biggest insurance companies did not really start on ICD-10 until this year, even though federal officials set the deadline in January 2009. “

I have defended my dissertation and completed my Ph.D

I can’t tell you how much work this whole thing has been!

Note to anyone hiring postdocs or profs: I identify as a cognitive scientist, not a psychologist. The University of Texas has notated my transcript to reflect my program of work (via the Interdisciplinary PhD path) as Medical Cognitive Science.

The title is “”Modeling the clinical predictivity of palpitation symptom reports: mapping body cognition onto cardiac and neurophysiological measurements.”

This dissertation models the relationship between symptoms of heart rhythm fluctuations and cardiac measurements in order to better identify the probabilities of either a primarily organic or psychosomatic cause, and to better understand cognition of the internal body. The medical system needs to distinguish patients with actual cardiac problems from those who are misperceiving benign heart rhythms due to psychosomatic conditions. Cognitive neuroscience needs models showing how the brain processes sensations of palpitations. Psychologists and philosophers want data and analyses that address longstanding controversies about the validity of introspective methods. I therefore undertake a series of measurements to model how well patient descriptions of heartbeat fluctuations correspond to cardiac arrhythmias.

First, I employ a formula for Bayesian inference and an initial probability for disease. The presence of particular phrases in symptom reports is shown to modify the probability that a patient has a clinically significant heart rhythm disorder. A second measure of body knowledge accuracy uses a corpus of one hundred symptom reports to estimate the positive predictive value for arrhythmias contained in language about palpitations. This produces a metric representing average predictivity for cardiac arrhythmias in a population. A third effort investigates the percentage of patients with palpitations report actually diagnosed with arrhythmias by examining data from a series of studies. The major finding suggests that phenomenological reports about heartbeats are as or are more predictive of clinically significant arrhythmias than non-introspection-based data sources. This calculation can help clinicians who must diagnose an organic or psychosomatic etiology. Secondly, examining a corpus of reports for how well they predict the presence of cardiac rhythm disorders yielded a mean positive predictive value of 0.491. Thirdly, I reviewed studies of palpitations reporters, half of which showed between 15% and 26% of patients had significant or serious arrhythmias. In addition, evidence is presented that psychosomatic-based palpitation reports are likely due to cognitive filtering and processing of cardiac afferents by brainstem, thalamic, and cortical neurons. A framework is proposed to model these results, integrating neurophysiological, cognitive, and clinical levels of explanation. Strategies for developing therapies for patients suffering from identifiably psychosomatic-based palpitations are outlined.

Proposed rules for Health Information Exchanges (HIE’s)

I have been discussing the issue of Health Information Exchanges alot lately: seems pretty critical to how the Obama-care plan will work in the real world. Wikipedia defines them as

the mobilization of healthcare information electronically across organizations within a region, community or hospital system.
HIE provides the capability to electronically move clinical information among disparate health care information systems while maintaining the meaning of the information being exchanged. The goal of HIE is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care. HIE is also useful to Public Health authorities to assist in analyses of the health of the population.
HIE systems facilitate physicians and clinicians meeting high standards of patient care through electronic participation in a patient’s continuity of care with multiple providers. Secondary health care provider benefits include reduced expenses associated with: duplicate tests, time involved in recovering missing patient information, paper, ink and associated office machinery, manual printing, scanning and faxing of documents, the physical mailing of entire patient charts, and manual phone communication to verify delivery of traditional communications, referrals and test results.

A blurb from Modern Healthcare hit my inbox about proposed regulations for these HIE’s:

The exchanges are a central component of the Patient Protection and Affordable Care Act and aim to provide subsidized coverage to at least 16 million people who have lacked coverage at some point in the past year.

The proposed rule spells out requirements states must meet if they opt to launch an exchange, or online marketplace of qualifying insurance plans. The federal government will launch exchanges in states that do not do so by 2014. The regulations also outline the minimum coverage health plans must provide in order to participate in any exchange.

“I think what the regulation sets out is a framework that says every state may choose a little bit different option,” HHS Kathleen Sebelius said in a news conference at a Capitol Hill hardware store. “We sent out some minimum standards, but the fact that some states may choose the active purchaser, like Massachusetts, and other states may use an open market, like Utah, is perfectly allowable and flexible,” she added. “And again, I think it’s important—these are choices of private insurers in an active market. This is not government insurance. It really is the private plans and again that’s really going to be a state-based stratetgy and choice.”

Finally, the proposed regulations spell out which companies may purchase coverage for their employees through the exchange. The healthcare reform law allows both individuals and employees of firms with 100 or fewer workers to purchase coverage—usually subsidized by taxpayers—on the exchange.

Steve Larsen, deputy administrator and director for CMS’ Office for Consumer Information and Insurance Oversight, said at Monday’s news conference that states will still have the option of developing their own exchanges even if they are not prepared for a federal review in January 2013.