ICD-10 has brought a new level of precision to the health care data ecosystem and it is starting to have an impact at Health Integrated. It has been a long road to ICD-10. It was first introduced by the World Health Organization in 1993. It has endured many attempts to bring it into the mainstream, replacing the longstanding ICD-9 world that has been sustained since 1979. The benefits of ICD-10 are many, but the top benefit for the data-driven health care enterprise is “precision.”
A major objective of ICD-10 is that it will help stimulate programs like patient-centered medical homes, value-based purchasing and accountable care organizations by giving the government and care management organizations better data to work with. Coding in ICD-10 requires an elevated clinical understanding of disease processes, the clinical factors behind a diagnosis and an ability to read and understand lab values and diagnostic reports. Since its inception in October, claims data that support health care payer information systems are starting to be populated with the much more detailed ICD-10 codes.
When ICD-9 was first developed, procedure terms like “laparoscopic” and “endoscopic” were unheard of. As an example, consider Disease Management codes for asthma: ICD-9 forced medical practitioners to choose intrinsic or extrinsic asthma, a choice that didn't match the realistic pathology of the disease. With the advent of ICD-10, the identification algorithms used to find patients have become more refined and we have a higher success rate in engaging these patients and helping them get the medical assistance they need to deal with their disease. As our precision in identification increases and more patients engage in programs meaningful to their conditions, there will be a natural decrease in health care costs from more precise and diligent treatment.
In addition to the precision ICD-10 now brings, there are a few other inherent benefits:
- ICD-10 improves the ability of public health officials to track diseases and threats, dangerous settings and even acts of bioterrorism that might otherwise go unrecognized.
- Fewer rejected and fraudulent claims – the potential for ICD-10 is that with more specificity, it will be a lot tougher for hospital coders to lump patients into more severe disease or procedure categories.
- ICD-10 aligns better with EHRs, and the transition to ICD-10 will assure that electronic medical records, value-based purchasing metrics, and meaningful-use incentive programs speak the same language.
9 Additional Benefits, as published by Tom Sullivan of “Healthcare IT News”
- Measuring the quality, safety and efficacy of care
- Designing payment systems and processing claims for reimbursement
- Conducting research, epidemiological studies and clinical trials
- Setting health policy
- Operational and strategic planning and designing health care delivery systems
- Monitoring resource utilization
- Improving clinical, financial and administrative performance
- Preventing and detecting health care fraud and abuse
- Tracking public concerns and assessing risks of adverse public health events
Cisco Perin is senior vice president, Technology and Information Strategy for Health Integrated.