Mad as hell
Congress and the POTUS, in their wisdom, have once again "delayed" implementation of the new diagnostic and inpatient procedure coding system, ICD-10, by a full year. The coming deadline, October 1, 2014, was sworn by CMS to be what is called in IT a "drop-dead" deadline.
The entire idea of modernising the system is anathema to certain well-funded interests in the medical industry. Evidently those interests have more clout than the interests who think it would make a great deal of sense to have the same system as the rest of the world, because they did more than kill the deadline. They turned this reform into a political bargaining chip, and made it obvious that implementation can--and probably will--be delayed indefinitely.
The other day, whilst having a beverage with friends not in health care, I alluded to the subject. This led one of them to indulge in mockery he had picked up somewhere. He had heard that the new system was full of ridiculous codes, far more than necessary.
Let us back up. This system, called the International Classification of Diseases, began as a method of keeping track of medical statistics, and broadened into one system for identifying diagnoses and another (used in the US for inpatient settings) for procedures. The details of the system vary from country to country, but the codes are much the same. When an American tells you that ICD-10 is absurdly detailed, it's a bit of American arrogance at work. To use my friend's example, why is it necessary to have a code for parrot bites? If he lived in a country with wild parrots, he might not ask. Those charged with tracking disease need to keep track of such things as psittacosis and avian influenza. The 35-year-old system America clings to only allows us to code "open wound." If the patient later presents with either of those diseases, it can be a mystery where it came from. Likewise, if you're Australian, codes that specifically identify a crocodile bite experienced whilst surfing is very important, as encounters between surfers and sea-going crocodiles appear to be on the increase in that country. Such things involve the integration of the actual diagnosis code with an entirely separate class of codes specifying where and why an injury happened or a disease was contracted. This is not new. It's been a feature of ICD coding for 50-plus years. My friend is keenly interested in statistics involving accidents between cars and bicycles. Given that cops (around here at least) are notoriously slack about reporting the details of such accidents, where does one think those statistics come from? They come from the coding of the circumstances of an accident. ICD-10 introduces a greater degree of granularity that is more and more needed in a complex world.
Since it appears the forces of reaction have won this one, let us think about why they are opposed.
First, it's one more change being presented to people unable to handle change. Second, it costs actual money up front, whereas the deficiencies of the present system cost theoretical money later--as in a malpractice suit that may or may not involve deficient diagnostic records. Third, physicians and surgeons have always had a problem understanding coding. This change places much higher demands upon clinicians to put detailed description in their notes. I find it hilarious that American doctors, who are seldom deficient in ego, are tacitly admitting that they can't learn a system that millions of secondary school graduates have learnt and are using around the world. So much for their conceit.
Since the next system, ICD-11, is already in beta in other countries, and since ICD-10 is already 10 years old, there are those who ask why the US shouldn't just skip to ICD-11. Short answer is learning curve. The principles and underlying technology of ICD-10 and 11 are much the same, although 11 takes them several steps further. Both are very different from ICD-9. Going from ICD-9 to ICD-11 is like changing, in a few weeks, from Ancient Minoan to any modern language. The present transition isn't nearly as daunting (unless you're a doctor). Keep in mind that those who oppose this change, and have now smelled blood in the water, will continue to oppose any transition.
So when you read snarky remarks about ICD-10, and are asked to pass them on, remember to ask cui bono? And don't be made a tool of reactionaries. The current decision is, as 3M Corporation says in its press release, a vote for the past.
The entire idea of modernising the system is anathema to certain well-funded interests in the medical industry. Evidently those interests have more clout than the interests who think it would make a great deal of sense to have the same system as the rest of the world, because they did more than kill the deadline. They turned this reform into a political bargaining chip, and made it obvious that implementation can--and probably will--be delayed indefinitely.
The other day, whilst having a beverage with friends not in health care, I alluded to the subject. This led one of them to indulge in mockery he had picked up somewhere. He had heard that the new system was full of ridiculous codes, far more than necessary.
Let us back up. This system, called the International Classification of Diseases, began as a method of keeping track of medical statistics, and broadened into one system for identifying diagnoses and another (used in the US for inpatient settings) for procedures. The details of the system vary from country to country, but the codes are much the same. When an American tells you that ICD-10 is absurdly detailed, it's a bit of American arrogance at work. To use my friend's example, why is it necessary to have a code for parrot bites? If he lived in a country with wild parrots, he might not ask. Those charged with tracking disease need to keep track of such things as psittacosis and avian influenza. The 35-year-old system America clings to only allows us to code "open wound." If the patient later presents with either of those diseases, it can be a mystery where it came from. Likewise, if you're Australian, codes that specifically identify a crocodile bite experienced whilst surfing is very important, as encounters between surfers and sea-going crocodiles appear to be on the increase in that country. Such things involve the integration of the actual diagnosis code with an entirely separate class of codes specifying where and why an injury happened or a disease was contracted. This is not new. It's been a feature of ICD coding for 50-plus years. My friend is keenly interested in statistics involving accidents between cars and bicycles. Given that cops (around here at least) are notoriously slack about reporting the details of such accidents, where does one think those statistics come from? They come from the coding of the circumstances of an accident. ICD-10 introduces a greater degree of granularity that is more and more needed in a complex world.
Since it appears the forces of reaction have won this one, let us think about why they are opposed.
First, it's one more change being presented to people unable to handle change. Second, it costs actual money up front, whereas the deficiencies of the present system cost theoretical money later--as in a malpractice suit that may or may not involve deficient diagnostic records. Third, physicians and surgeons have always had a problem understanding coding. This change places much higher demands upon clinicians to put detailed description in their notes. I find it hilarious that American doctors, who are seldom deficient in ego, are tacitly admitting that they can't learn a system that millions of secondary school graduates have learnt and are using around the world. So much for their conceit.
Since the next system, ICD-11, is already in beta in other countries, and since ICD-10 is already 10 years old, there are those who ask why the US shouldn't just skip to ICD-11. Short answer is learning curve. The principles and underlying technology of ICD-10 and 11 are much the same, although 11 takes them several steps further. Both are very different from ICD-9. Going from ICD-9 to ICD-11 is like changing, in a few weeks, from Ancient Minoan to any modern language. The present transition isn't nearly as daunting (unless you're a doctor). Keep in mind that those who oppose this change, and have now smelled blood in the water, will continue to oppose any transition.
So when you read snarky remarks about ICD-10, and are asked to pass them on, remember to ask cui bono? And don't be made a tool of reactionaries. The current decision is, as 3M Corporation says in its press release, a vote for the past.
Labels: ICD-10
posted by Uncle | 16:58
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