Revenue Cycle Blog

By Carole Hodsdon, Executive Vice President and Chief Technology Officer, MEDecision

I’ll admit it. In the fall of 1999, I was one of the many IT professionals who waited until the very last minute to ensure that their company’s technology was Y2K compliant. In fact, in October and November of that year I aged significantly. Two months with virtually no sleep will do that to you.

So you think I would have learned my lesson a few years later when it was time to ensure compliance with the then-new HIPAA regulations for electronic transactions. No, once again, despite ample fair warning, my team and I kept putting it off until it was down to the wire. And once again, I aged 10 years in a matter of about six weeks.

I’m fairly certain I’m not the only one. All of you fellow regulations procrastinators out there can now make yourselves known. It’s OK.

But please, whatever you do, join me in vowing not to make the same mistake again when it comes to the looming ICD-10 deadline. Let’s learn from our past mistakes and not think of October 2013 as some far-off, distant time only to wake up one morning in July of 2013 in an utter panic. By now, we should all be well aware of what happens to he (or she) who hesitates.

Our ICD-10 implementation work has already begun here at MEDecision and, thankfully, it appears a growing number of other organizations have started too. While it may be a bit premature to finalize a fully vetted plan, my experience recently has revealed that a lot of companies have at least put the ICD-10 deadline on their proverbial radar and have begun thinking about it. That in and of itself is a pretty good place to start.

As we learned from Y2K and HIPAA, these things are scary and intimidating. And with all of our other day-to-day responsibilities monopolizing our precious time, it’s no wonder we put them off. But health care organizations, particularly insurers, have a real opportunity — now — to spare themselves a lot of grief in a few short years. When the ICD-10 switch goes on in 2013, you can’t just assume you’re going to start receiving ICD-10 claims exclusively. There is inevitably going to be some crossover, and now is the time to start planning for how to deal with that. Larger payers have an even greater challenge since many of them deal with more than one claims system.

So let’s make it a point this time to not wait until the last minute. If ICD coding is the guts of your system(s), start planning now. It’s not necessary to stop the presses and focus on this and this only, but it would behoove us all in the long run to start running some test cases to see what happens. If you get an ICD-10 claim in your system, mock it up, see what it’s going to look like and what it’s going to do. Wouldn’t you rather find out now whether it’s going to send your system into a complete meltdown or process the way you’d like it to? It’s better than waiting until you only have a matter of weeks to get things right. And don’t just make testing a one-off thing — conduct tests regularly so you can work out all of the bugs in a timely and thoughtful way.

If we all start planning now, we can all breath a collective sigh of relief when the fall of 2013 rolls around.

www.medecision.com

As we all know, health IT is expected to play a large role in any eventual reform measures. And indications are that ensuring quality, medical necessity and the delivery of best practice medicine will be the centerpiece of the health IT strategy.

One relatively simple way to advance this effort would be to use existing automated clinical criteria technology in the administration of Medicare and Medicaid; not in the traditional unpopular managed care sense, but positioned as a quality assurance mechanism. The automation would absolutely minimize the administrative cost for physicians’ and hospitals’ staffs and, ultimately, improve the quality of care and save us all money by ensuring the medical necessity of high-cost services. Medicare and Medicaid could be assured that about 85 percent of hospital admissions, surgeries and other procedures met best-practice guidelines through fully-automated computerized processes; the remainder would potentially require QIO physician discussions.

The biggest hurdle to this approach is the probability that some would mislabel it “utilization management” and, by association, “managed care.” Admittedly, it is managing care to some extent. But it’s not the managed care that has come to be met with such negative passion by some over the past two decades. The technology need not be used to determine network affiliations or adherence to some complex commercial benefit plan; it would merely support the use of best practice medicine to foster optimal treatment. We wouldn’t even have to issue denials of payment if a doctor chose to proceed in spite of the outcome of the analysis for an individual patient — we could focus on education instead. Marketing and communications efforts would need to clearly position the effort as a quality assurance process, and making it simply part of our national health IT strategy to promote evidence-based medicine (already on the agenda) and help foster the best outcomes from the outset would be a great start.

There is little doubt that some iteration of health care reform is coming and in order to pay for it, we must find ways to lower costs. The two current options for saving Medicare and Medicaid dollars are either lowering reimbursement rates or raising taxes. Either way, consumers will wind up footing the bill. But it certainly doesn’t have to come to that. Instead, we can rather simply and affordably implement existing technology to improve quality, lower waste and ensure better care. In the big picture, it would be a relatively small expenditure that would more than likely generate a sizable return on investment. Rather than relying on the American people to subsidize an economic bailout of government programs, we could invest in American innovation to solve one of our country’s most serious problems. It’s a plea the health IT industry has been making for some time and one of those incredibly rare circumstances where so much can be gained with virtually nothing to lose.

David St.Clair founded MEDecision, a leading provider of collaborative health care management solutions, in 1988 and has served as the chief executive officer since 1988. You can learn more about MEDecision at www.MEDecision.com and subscribe to an RSS feed at http://www.MEDecision.com/blog/. Contact David at This e-mail address is being protected from spambots. You need JavaScript enabled to view it and follow the company on Twitter at @MEDecision.