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ICD-10: No IT let-up for providers and payers

By George Schwend, president and chief executive officer, Health Language

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Fresh off meeting compliance with the HIPAA 5010 transaction set that is the precursor to the ICD-10 diagnosis and procedural codes, providers and payers can’t spend much time doing a victory lap because the transition to ICD-10 will have them jumping out of the frying pan into the fire. The conversion from ICD-9-CM to ICD-10-CM/ PCS, which will increase diagnosis and procedure codes almost tenfold from 15,000 to 140,000, will significantly impact providers’ and payers’ bottom lines. Organizations that believe ICD-10 is just a technology issue will face a rude awakening once they realize that ICD-10 will require dramatic changes in physician behavior and impact how nearly every department within a group practice, hospital or payer organization works. In addition to identifying and upgrading all information systems that use ICD-9, entities must simulate the impact of ICD-10 codes to preemptively identify areas where they will potentially gain or lose reimbursement dollars, work with doctors to improve clinical documentation practices to successfully mitigate risk and migrate to ICD-10, overhaul revenue cycle processes, train coders and educate their workforce by Oct. 1, 2013. While some organizations will overcome the challenge, others may not in time. Those that fall short, as well as those lacking the capital to make the transition, may actually struggle to survive. As a result, we may see increased provider and payer consolidation this year. The bottom line is that 2012 will

be all about ICD-10, including how organizations deploy medical terminology-management tools to manage the new codes and other data standards. Entities that complete this necessary work will be in an excellent position to capture, leverage and analyze an enormous amount of information to enhance care, measure outcomes and reduce costs in a rapidly changing environment.

High-performing organizations emerge from the pack

By John Haughton, M.D., M.S., chief medical information officer, Covisint

As the nation’s healthcare delivery system begins to shift from a volume- based to a value-based approach, 2012 will emerge as a pivotal year for many healthcare organizations, including hospitals, independent delivery networks (IDNs), physician practices and public/ private health information exchanges (HIEs).

Driving this transition, the Centers for Medicare and Medicaid Services (CMS) and Congress have enacted an alphabet soup of regulations and legislation – ACOs (accountable care organizations), PCMHs (patient- centered medical homes), MU (meaningful use), P4P (pay for performance) to name just a few. However, not all healthcare organizations will adapt easily to the new healthcare ecosystem. As the healthcare landscape transforms, healthcare

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providers must also evolve into high-performing, innovative organizations. They must continuously enhance clinical, operational and fi nancial outcomes by communicating, aggregating and analyzing data to generate useful, timely and intelligent care. They will require an HIT infrastructure that provides seamless interoperability and clinical communication while offering a wide array of benefi ts, ranging from facilitating evidence-based care to enabling coordination throughout the care continuum. For long-term sustainability, all types of HIEs must demonstrate ongoing, measurable value. It sounds simple, but in many cases it requires the right technology and mindset to support a new way of thinking about the HIE’s purpose, which has often focused on the narrow task of capturing and securely moving data. In 2012, there will be mounting pressure for HIEs to quickly and accurately aggregate the data to create 360- degree, real-time patient clinical views, as well as to analyze the data to produce useful intelligence about specifi c patient populations to improve the quality of care. This population reporting will also

facilitate the development of evidence-based care guidelines that can be shared throughout the community to help hospitals and physicians implement best practices and identify outliers. Government and private payers are increasingly aligning payments with quality and outcomes, which will be a boon for those organizations that successfully pursue and enable high-performance care. Those organizations that win will build sustainable bridges across their community data islands.


January 2012


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