Viewpoint

Who really wins with ICD-10?

FROM THE CHIEF MEDICAL EDITOR Larry E. Patterson, MD

First a pop quiz about this month’s cover topic, the changeover to ICD-10 — the 10th revision of the International Statistical Classification of Diseases and Related Health Problems — brought to you by the people at the World Health Organization:

1. Will ICD-10 improve your ability to provide health care to your patients?

2. Will ICD-10 improve your ability to efficiently run your practice?

3. Will ICD-10 improve the status of your practice’s financial health?

If you answered “No” to all three questions, congratulations! You correctly answered that ICD-10 will in no way benefit you or your patients. The bad news is that, for you, there really is no other good news. (For more thoughts, see our cover article on page 22.)

With the last major government mandate of EHR, there were some positives. The government partially defrayed the costs if you got started early enough and if you completed many seemingly extraneous tasks. EHR really does offer a number of advantages over paper charts. Implementation is painful, but I can’t say I’d ever go back to paper. And if you decided against it, you could just take the financial penalty … for now.

On the other hand, ICD-10 could be the straw that breaks the camel’s back. There is no financial help for implementation. Again, it in no way benefits you, your practice or your patients. And finally, you don’t have a choice. Implement ICD-10 by October 1, 2014, or you won’t be paid.

So what will happen? I’m predicting, at the dawn of the questionably named Affordable Health Care Act, with a sudden surplus of patients straining an already over-stressed health-care system, you will be seeing a number of even earlier retirements from medicine. That is, if EHR, HIPAA, SGR, sequestration and so on, haven’t been enough.

Big practices should be more prepared with their umbrella of administrators, CEOs, COOs and IT departments. The little guys like me and many of you are just now learning how much of a nightmare this is about to become. Perhaps the biggest change of all will be training our doctors and staff to learn a whole new way of documenting things. I’ve always done my own coding. It’s quick, thorough and accurate.

But with ICD-10 I may have little choice but to hire a full time coder (or coders?) because it won’t be financially viable to sit for several minutes with each patient determining the best set of diagnostic codes. Of course, I won’t be reimbursed for the extra staff I’ll have to hire. Nor for the massive training that all our doctors and staff will have to undergo over the next few months.

Almost forgot. Will all the EHR vendors and insurance companies be ready? Sure they will. But, just start stockpiling as much of a financial reserve as you can between now and then. You might be asking, whom will all this benefit? I’ve run out of room, but I’ll bet you all can figure that one out all by yourselves. OM