January 21, 2013
Trends In Health Care IT: They’re Not All Positive
By Michael D. Shaw
We are less than a year away from the 2014 goal of substantially switching over to electronic health records (EHR). While adjustments will likely occur, here are two key deadlines:
October 1, 2014 Eligible hospitals and CAHs (Critical Access Hospitals) that do not successfully demonstrate meaningful use of certified EHR technology will be subject to Medicare payment adjustments beginning in FY 2015.
October 1, 2014 (extended from October 1, 2013) Mandatory full implementation of ICD-10. The World Health Organization (WHO) publishes the International Classification of Diseases (ICD) code set, which defines diseases, signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. At present, ICD-9, originally published in 1977, is being utilized in the United States, although ICD-10 has been used in most other countries for some time.
Coding, of course, is vital as it is the key to getting paid. The theory is that “The added detail embedded within ICD-10 codes informs health care providers and health plans of patient incidence and history, which improves the effectiveness of case management and care coordination functions. Accurate coding also reduces the volume of claims rejected due to ambiguity.”
As you might expect, there are numerous differences between ICD-9 and ICD-10. For one thing, ICD-10 provides for 68,000 codes, compared to around 13,000 in the older system. Given the increased field length of the codes (from five to seven characters), far more detailed descriptions of the conditions are possible within ICD-10.
To its credit, the Centers for Medicare & Medicaid Services (CMS) do not minimize how burdensome the transition from ICD-9 to ICD-10 will be. Indeed, its publications provide suggestions and timetables on implementation. Missing from all the helpful hints is exactly how hospitals and medical offices are expected to pay for it, especially in light of the reduced reimbursements mandated by Obamacare.
With most of the mainstream media studiously ignoring the many “unintended” consequences of so-called health care reform, you may not have heard about the letter sent to Marilyn B. Tavenner, the Acting Administrator of CMS. This letter, dated December 20, 2012, was signed by 81 groups, representing most state medical associations, and essentially all medical specialties.
After thanking CMS for extending the ICD-10 implementation deadline, the organizations unload a few zingers:
1. CMS is reminded that the American Medical Association has called on the agency to “[E]liminate the implementation of ICD-10, and to immediately reiterate that the burdens imposed by ICD-10 will force many physicians in small practices out of business.”
2. The implementation of ICD-10 will create significant burdens on the practice of medicine with no direct benefit to individual patient care, and will compete with other costly transitions associated with quality and health IT reporting programs.
3. [Implementation] is a massive administrative and financial undertaking for physicians, requiring education, software, coder training, and testing with payers. Physicians will be responsible for all of these costs, which, depending on the size of a medical practice, will range from $83,290 to more than $2.7 million.
4. Physicians are also facing present and future financial penalties if they do not successfully participate in multiple Medicare programs already underway, including e-prescribing, EHR meaningful use, and the Physician Quality Reporting System (PQRS) and value-based modifier programs.
5. The compounding effect of these potential penalties is made worse by the up to two-year lag time between the periods for measuring performance and applying penalties—making it impossible for physicians to learn about and correct errors and avoid penalties before ICD-10 implementation begins.
Also receiving scant media coverage is the fact that the biggest cheerleader for conversion to EHR—RAND Corporation—is now walking back from some of the rosy predictions made in its highly influential 2005 report entitled “Analysis of Healthcare Interventions That Change Patient Trajectories.” (Don’t you just love that hip use of aggressive military language in an uber-geek setting?)
I guess no one noticed at the time that the report was sponsored by Cerner Corporation, General Electric, Hewlett-Packard, Johnson & Johnson, and Xerox—all heavily involved in EHR. It is noted that Cerner’s revenue has nearly tripled since the report was released, to a projected $3 billion in 2013, from $1 billion in 2005.
But, no worries. According to RAND’s website, they’re all about objective analysis and effective solutions.
Meanwhile, health care IT still has to keep its networks operating on a mission critical basis, and that often involves the use of vendors offering managed IT services. Michael Hosey, founder and president of Woodland Hills, CA based My Instant Guru explains…
“Managed IT is an essential component for health care providers, where regulatory and compliance issues demand the technical expertise of established professionals. Companies like My Instant Guru enable health care organizations to focus on or improve in two key areas: productivity and overall success.”
“We design and implement network services based on the specific business processes of each health care client, which allows them to protect their informational assets, capitalize on new opportunities, expand the breadth of their reach and have a scalable, flexible IT infrastructure. This customized solution is the foundation of managed IT services, for which we continue to develop a series of leading and innovative programs.”
Well said. And considering how the deck seems to be stacked against them, health care providers need all the help they can get.