President’s Council of Advisors on Science and Technology urge faster shift to value-based payment – New Ideas for Creating Change

Healthcare

Monumental changes must occur so our healthcare system can transition to value-based care. The change required for providing and paying for healthcare using a completely different model is analogous to moving the Moon closer to Earth so we can have another place where we can vacation. The task is enormous and a very important one. It begins with the payer’s decision to adopt a value-based reimbursement model so the rest of the industry can support the change and begin delivering healthcare in a completely different way.

We should lean on payers to belly up to the bar and begin the reconstruction needed to affect the massive change. Changing the payment structure of healthcare is projected to improve the overall health of our citizens. I’m certainly in favor of that. At the same time, we should ask President Obama and his team at the White House to work toward simplifying the tax code, reducing taxes and stimulating the economy so patients have the money to pay their higher Healthcare Exchange Insurance costs, higher deductibles and higher co-pays. Enjoy the rest of this article. Click here if you would like to research the President’s Council of Advisors on Science and Technology’s report. – Phil C. Solomon

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June 3, 2014 | TODAY’s TOP STORY: Insurers should speed up the adoption of value-based reimbursement so the entire healthcare industry can implement systems-engineering principles that will boost efficiency of care, says a new report from the President’s Council of Advisors on Science and Technology.

Systems-engineering principles, which already have benefited other industries, analyze and measure complex systems to improve efficiency, productivity and quality, PCAST notes. Implementing these tools could help payers and providers eliminate one of the root causes of rising healthcare costs–inefficient care. But a systems-engineering method can’t be applied until insurers shift away from fee-for-service payment to a value-based system.

The current fee-for-service payment is exactly what encourages inefficient care. And although a “small number of healthcare organizations” have implemented systems-engineering into their processes with “dramatically positive results,” the report says incorporation on a widespread scale requires value-based payment as the dominant reimbursement method.

“To support needed change, the nation needs to move more quickly to payment models that pay for value rather than volume,” PCAST Co-Chairs John Holdren, director of the Office of Science and Technology Policy, and Eric Lander, president at the Broad Institute of Harvard and MIT, wrote in the report’s cover letter to President Barack Obama. “These new payment models depend on metrics to identify high-value care, which means that strong quality measures are needed, especially about health outcomes,” they wrote.

With widespread use of value-based care, the U.S. healthcare system can apply systems-engineering to redesign processes of care around the patient, in conjunction with support from community and medical resources, according to the report.

The PCAST also recommended the U.S. Department of Health and Human Services lead efforts to develop a “robust” national health information infrastructure, including urging providers to adopt interoperable electronic health records, FierceHealthIT previously reported.

To learn more: – here’s the report (.pdf)

By  – Subscribe at FierceHealthPayer

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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What processes have you put into place to effect CDI?

  • Meaningful Use Stage 2, including Electronic Medication Administration Records
  • ICD10, including clinical documentation improvement and computer assisted coding
  • Replacement of all Laboratory Information Systems
  • Compliance/Regulatory priorities, including security program maturity
  • Supporting the IT needs of our evolving Accountable Care Organization including analytics for care management

One part that crosses the 5 work streams is how electronic documentation should support structured data capture for ICD10 and ACO quality metrics.

How are most inpatient progress notes documented in hospitals today? The intern writes a note that is often copied by the resident which is often copied by the attending which informs the consultants who may not agree with content. The chart is a largely unreadable and sometimes questionably useful document created via individual contributions and not by the consensus of the care team. The content is sometimes typed, sometimes dictated, sometimes templated, and sometimes cut/pasted. There must be a better way.

Imagine the following — the entire care team jointly authors a daily note for each patient using a novel application inspired by Wikipedia editing and Facebook communication. Data is captured using disease specific templates to ensure appropriate quality indicators are recorded. At the end of each day, the primary physician responsible for the patient’s care signs the note on behalf of the care team and the note is locked. Gone are the “chart wars”, redundant statements, and miscommunication among team members. As the note is signed, key concepts described in the note are codified in SNOMED-CT. The SNOMED-CT concepts are reduced to a selection of suggested ICD-10 billing codes. A rules engine reports back to the clinician where additional detail is needed to justify each ICD-10 code  i.e. a fracture must have the specifics of right/left, distal/proximal, open/closed, simple/comminuted.

The following is a new process designed to improve the capture of data and create better work flows for coding.

Module 1  – disease specific templates

Module 2  – technology to capture free text and populate the templates i.e. my Wikipedia/Facebook concept describe above.

Module 3  – natural language processing to codify SNOMED-CT concepts

Module 4  – mapping of SNOMED-CT concepts to ICD10 codes

Module 5  – rules to ensure documentation is complete enough to justify the ICD10 codes

Industry leaders like Kaiser, Geisinger and Mayo are already working on elements of this approach. There will be challenges. They are:

1.  Clinicians are not broadly trained in the use of SNOMED-CT. It may be that SNOMED-CT should be used for internal storage of structured data but only friendly plain text descriptions are displayed to users.

2.  Will CMS, the Joint Commission, and malpractice insurers accept the concept of jointly authored care team notes?

3.  Implementing all 5 applications/modules at once may be too much change too quickly, making the overall project high risk

4.  Will SNOMED-CT map to ICD-10 cleanly enough to ensure neither upcoding nor downcoding, but “right coding”

5.  Will companies be willing to create such modules/services at a time when few EHRs are likely to interface to them? As Meaningful Use Stage 3 is finalized, I expect some of this functionality to be required

We now have 15 months before ICD-10 compliance is required and complete documentation in support of the new codes must be available. The radical change must happen quickly in order to experience the full benefit. What are your thoughts?

Read the complete article here 

Author: John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician.

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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This post isn’t focused on the attributes and success of a healthcare leader. It highlights the strength and commitment any leader must possess to succeed at any endeavor they choose.

I read this article about Sara Blakely and was astonished at the success she has achieved. The real story is not Sara’s rise to become the top woman billionaire in the world, but the rules she followed to achieve greatness. Below are 5 simple rules anyone can follow to become successful in their business life.

Healthcare Leaders

Blakely launched a start-up with $5000 in savings to becoming the youngest self-made female billionaire in history. She has a net worth of $979.1 Million, is listed on Forbes as the #1565 of Billionaires worldwide, #474 of Billionaires in United States and #90 of the most powerful women in the world.

She experienced business success through her vision that women of all sizes can look great, regardless of what they decide to wear. You see, Blakely gave the world Spanx: the world’s first invisible pants.

Given her notable first in the Global Rich List, you might think that Blakely is a completely driven alpha female. Interviewers have remarked on her incredible energy and passion for helping women look and feel their best, but also on a vulnerability, empathy and honesty which they have found most endearing.

These qualities are reflected in Blakely’s answer to the question, “What advice would you give entrepreneurs or intrepreneurs?”

  1. Pay it forward. Solve people’s problems, make their lives easier, make them happier and the money will follow.
  2. Go with your gut. It seems to know things your head doesn’t.
  3. Push through your fear. Blakely says she was terrified when she started her business and still pushes herself through her fears every day, which include flying all over the world, despite a chronic fear of flying.
  4. Spend time each day on your own: ideally at least half an hour in silence. Blakely says that the best ideas always come to her while she is having her evening soak in the bath.
  5. Believe in your work and treat failure as a key part of the process. Blakely said she heard the word “No” over a thousand times before someone first said “Yes” to her idea.

Great Healthcare leaders are not born, they rise to the top because of their desire to succeed, their commitment to their organization and their strength to break through any impediment in order to achieve success.

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

 

 

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7 Strategies to Stay The Course – Continue Preparing for ICD-10 Transition

CLICK THIS LINK TO VIEW THE ICD-10 DEBATE

ICD-10

Today the Senate is scheduled to vote on a bill (HR 4302) that would implement a temporary fix for Medicare’s sustainable growth rate formula and delay the ICD-10 compliance deadline until 2015, The Hill’s “Floor Action” reports. Regardless of the outcome, providers must stay the course and continue preparing for the ICD-10 launch. It is wise to continue to follow your readiness path.

1. Completed coder and CDS training and evaluated productivity
• Finalize coder and CDI training to begin dual coding and assist with communicating with clinical staff
• Evaluate outsourcing options (consider safety net strategy) and begin to contract now
• Secure additional hires and provide training-bring coders in house for 30-60 days Sept 15th to November 15th and create a code at home program
• Prepare for an increase in denials, follow-up & other tasks expected due to the transition. Consider assistance from internal staff and/or outsourcing for all related front end and back-end processes

2. End to end testing
• When and how will you “dual code”? When will you begin?
• When will all your vendors be ready for integrated testing?
• Co-ordinate the measurements of workflow changes of ICD-10 with clinical, financial and quality and what will the reporting look like in these areas? What will be the impact to each area?

3. Review impact of ICD-10 by specialty
• Select a sample set of completed charts – highest Case Mix Index
• Natively code charts using ICD-10 (Without using a mapping tool) and outline the gaps in the documentation and create a public report to the clinical staff

4. Technical Testing Strategy
• Validate where the payers, clearinghouse, and other associated vendors are with their planning and quality assurance

5. ICD-10 Interface Testing
• Created a deadline of when you will test interfaces and how you will test them.

6. Map Out Your 2014 – 2015 Clinical Training Plan
• Have a Physician Advisory Role
• He or she should be attending department meetings and ICD-10 – a meeting agenda item in all sessions
• Finalize a plan for physician training to include all tools
• Schedule on-site physician specialty training securing dates and rooms
• Clinical documentation tutorials or advisory sessions should be mapped out with a mandate to hours of completion
• Schedule Physician advisory and CDS staff to attend physician departmental meetings and provide ICD-10 documentation specificity essentials and guidelines

7. Additional Points for Consideration • Have you incorporated CAC or CDI into your ICD-10 strategy? • Important: CMS testing is not end to end testing. There will be no adjudication of claims to provide payment information • Verify if your claims clearinghouses offers similar testing where the provider sends test claim files and the clearinghouse will apply basic ICD-10 edits to the test file

Content provided by Lyman Sornberger. Presentation created by Phil C. Solomon

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

 

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7 Strategies to Stay The Course – Continue Preparing for ICD-10 Transition

CLICK THIS LINK TO VIEW THE ICD-10 DEBATE

ICD-10

Today the Senate is scheduled to vote on a bill (HR 4302) that would implement a temporary fix for Medicare’s sustainable growth rate formula and delay the ICD-10 compliance deadline until 2015, The Hill’s “Floor Action” reports. Regardless of the outcome, providers must stay the course and continue preparing for the ICD-10 launch. It is wise to continue to follow your readiness path.

1. Completed coder and CDS training and evaluated productivity
• Finalize coder and CDI training to begin dual coding and assist with communicating with clinical staff
• Evaluate outsourcing options (consider safety net strategy) and begin to contract now
• Secure additional hires and provide training-bring coders in house for 30-60 days Sept 15th to November 15th and create a code at home program
• Prepare for an increase in denials, follow-up & other tasks expected due to the transition. Consider assistance from internal staff and/or outsourcing for all related front end and back-end processes

2. End to end testing
• When and how will you “dual code”? When will you begin?
• When will all your vendors be ready for integrated testing?
• Co-ordinate the measurements of workflow changes of ICD-10 with clinical, financial and quality and what will the reporting look like in these areas? What will be the impact to each area?

3. Review impact of ICD-10 by specialty
• Select a sample set of completed charts – highest Case Mix Index
• Natively code charts using ICD-10 (Without using a mapping tool) and outline the gaps in the documentation and create a public report to the clinical staff

4. Technical Testing Strategy
• Validate where the payers, clearinghouse, and other associated vendors are with their planning and quality assurance

5. ICD-10 Interface Testing
• Created a deadline of when you will test interfaces and how you will test them.

6. Map Out Your 2014 – 2015 Clinical Training Plan
• Have a Physician Advisory Role
• He or she should be attending department meetings and ICD-10 – a meeting agenda item in all sessions
• Finalize a plan for physician training to include all tools
• Schedule on-site physician specialty training securing dates and rooms
• Clinical documentation tutorials or advisory sessions should be mapped out with a mandate to hours of completion
• Schedule Physician advisory and CDS staff to attend physician departmental meetings and provide ICD-10 documentation specificity essentials and guidelines

7. Additional Points for Consideration • Have you incorporated CAC or CDI into your ICD-10 strategy? • Important: CMS testing is not end to end testing. There will be no adjudication of claims to provide payment information • Verify if your claims clearinghouses offers similar testing where the provider sends test claim files and the clearinghouse will apply basic ICD-10 edits to the test file

Content provided by Lyman Sornberger. Presentation created by Phil C. Solomon

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

 

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Check out: ICD-10 – The Great Debate – Presentation by Phil C. Solomon

Article – Latest ICD-10 one-liner is no joke

WASHINGTON | March 28, 2014
 Tom Sullivan, Editor, Government Health IT did a great job in this article highlighting the debate over the (need or not) ICD-10 implementation in an easy to understand (non political speak) summary from all sides of this angry and complex debate. PCS -

ICD-10ICD-10
 has been the butt of countless jokes during the last several months but none so surprising as the latest one-liner. Only this isn’t funny. 

Whether you’re on that chair edge hoping President Obama gets a chance to sign the provision pushing ICD-10 back within the Sustainable Growth Rate fix into law, or crossing fingers that the Senate kills it come Monday, no matter. The reality is that a code set conversion simply should not be about politics.

Other than lazily dumping ICD-10 and the SGR process for determining how much to pay doctors who treat Medicare patients under the umbrella term of healthcare reimbursements, the tie between them prior to the now infamous Section 212 bomb within the bill, ICD-10 and SGR have almost nothing to do with each other.

Proponents of ICD-10 have made the case for years that the U.S. needs the modern classification system as a key piece of digitizing the last multi-trillion dollar sector to be industrialized. Opponents, likewise, have been vocal that the immediate benefits are unproven, even by countries such as Canada and Australia that have been using ICD-10 for years, insisting that the ride may not be worth its ticket price for those who actually have to use the codes and pay for that privilege, and questioning just how modern ICD-10 will be when it’s live in production.

And those are the truncated versions. So, here’s the rub: Ample evidence exists to support either argument. Anyone, politician or otherwise, could easily extract that to build earnest and learned debate

But that is not what happened here. Rather, someone essentially snuck in one line (I’ve stripped out the legalese for you) saying “the Secretary of Health and Human Services may not, prior to October 1, 2014, adopt ICD-10 code sets as the standard for code sets.”ate — to discuss the merits of ICD-10, explore alternate pathways forward, to consider options, weigh them against each other and then to decide what’s really best for the country, doctors, patients and, yes, even taxpayers who rarely use the healthcare system.There’s a lot in this bill, after all, and it makes for downright boring reading — even for those of us bearing some manner of fascination with healthcare policy.

That and the slight window of time between U.S. Representatives learning of this latest attempt to finally sort through the SGR Medicare doctor payment fiasco and Thursday’s odd vote could help explain why so many members of the House had yet to even wade through it before the verbal vote; several Representatives raged against that lack of awareness on the floor. And some of them, most notably Minority Leader Nancy Pelosi (D-CA), simultaneously decried the bill as “a missed opportunity” to permanently correct the SGR while saying “I myself come down on the side of supporting the legislation,” because she does not want to give Republican rivals another chance to blame this on the Affordable Care Act.

Absent informed debate about the bill’s content, Democratic Whip Steny Hoyer, a Maryland Democrat, even threw down the gauntlet, challenging any House Representative to step forward and say they actually read it. No one answered that call on Thursday. And none have since, at least not publicly.

And that is our American government in action.

Written by:  Tom Sullivan, Editor, Government Health IT

[See also: House votes to delay ICD-10, fix doc pay.]

[See also: Twitter reacts to ICD-10’s delay.]

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

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Following House’s lead, Senate introduces bill to repeal ICD-10

ICD-10… what a conundrum, right? Early last year, many of my colleagues had pontificated about the possibly of the ICD-10 transition would be pushed back. I was one of those who thought that “healthcare” had delayed roll outs for other pending legislation and there was no way they would delay ICD-10. Well I may have been wrong. Could it happen? It sure could. I’m going to sit back and enjoy the ride as developments unfold…. Here’s another idea, should we just forget about the ICD-10 mess and wait until 2017 for ICD-11?

I am still working with my client’s, who are planning ahead and beefing up their coding resources in anticipation of the potential catastrophic reduction in productivity which is on the way. With all of the ICD-10 talk, it’s got me thinking. This time in history is like riding a healthcare roller coaster. When you get off the ride, you’ll either be sick or act like you just had the thrill of your life. – PCS

ICD-10

A bill seeking repeal of the ICD-10 code set is now in both chambers of Congress after its introduction to the U.S. Senate last month.

The Cutting Costly Codes Act of 2013External Link, which was first introduced into the U.S. House of Representatives in April, would prohibit the U.S. Department of Health and Human Services from implementing, administering or enforcing current regulations that require the new code set to take effect Oct. 1, 2014. The bill was introduced to the Senate May 16 by Senators Tom Coburn, MD, R-Okla., John Barrasso, MD, R-Wyo., Rand Paul MD, R-Ky., and John Boozman, R-Ark.

In addition to repealing implementation of the ICD-10 code set, the legislation also would require a federal study on ways to mitigate the disruption any replacement of the ICD-9 code set would cause for physicians and other health care providers.

The AMA has voiced strong support for the legislation, including a formal letterPDF FIle sent to Rep. Ted Poe, R-Texas, the day he submitted the bill to the House.

“The differences between ICD-9 and ICD-10 are substantial, and physicians are overwhelmed with the prospect of the tremendous administrative and financial burdens of transitioning to the ICD-10 diagnosis code set with its 68,000 codes—a five-fold increase from the approximately 13,000 diagnosis codes currently in ICD-10,” the letter states.

Experts say the new code set will affect not only claims submissions but also such processes as patient eligibility verification, pre-authorization for services, documentation of patient visits, research activities, and public health and quality reporting. The cost for individual physician practices to adopt ICD-10 is estimated to be around $83,000 for a small practice and as much as $2.7 million for a large group practice.

At the same time, physicians should make preparations for the new code set to avoid disastrous results if ICD-10 is rolled out as planned. Those who aren’t ready by next year’s deadline will not receive payment for their services. Resources to help physicians prepare are available on the AMA’s ICD-10 Web page and through the AMA StoreExternal Link.

The AMA will continue to work with members of Congress toward a solution to ensure physicians’ practices are not disrupted as the result of implementation of a new code set.

This post can be seen on the AMA website

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Phil C. Solomon is a healthcare finance, clinical documentation and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation improvement, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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Fitch: Non-Profit Hospitals Face Negative Credit Potential from ICD-10 Conversion

ICD-10NEW YORK–()–While the financial impact of the conversion to ICD-10 is expected to be manageable for non-profit hospitals, the potential for revenue cycle disruption may have negative credit reverberations, according to a new Fitch Ratings report.

‘It is a challenging time as health care reform moves forward and other pressures, such as sequestration, inpatient volume declines, and reduced reimbursement, are being felt. ICD-10 conversion will bring additional costs at a time when hospital operations are already under pressure,’ said Gary Sokolow, Director in the U.S. Public Finance Group.

ICD-10 directly affects the central components of hospital reimbursement – coding, billing, and payment. Further complicating the change is the simultaneous transition of government and private payors to ICD-10.

While providers and payors have had ample time to prepare for transition to ICD-10 there is a heightened potential for payment delays and disruption. Fitch believes the solid liquidity position of investment-grade rated hospitals and health systems should help weather short-term pressure.

For more information, a special report titled ‘Hospital Hot Topic: ICD-10 Conversion’ is available on the Fitch Ratings web site at www.fitchratings.com.

Additional information is available at ‘www.fitchratings.com‘.

Applicable Criteria and Related Research: Hospital Hot Topic: ICD-10 Conversion

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The real reason doctors hate ICD-10 – They struggle with new quality mandates and IT meaningful use requirements, while having to comply with the new CMS mandate.

“Once initiated, ICD-10, will be like a turtle stuck upside down on his shell,  it will not be easy to flip over and catch up with the rabbit hare (Phil C. Solomon).

Kevin MD blog by IRA NASH, MD – MARCH 10, 2014

ICD-10It has been freezing cold in much of the country for the last two months, but things have been heating up in the controversy over the implementation of ICD-10. First, a quick primer for those of you who have not been following this.The “ICD” in ICD-10 stands for International Classification of Diseases. The “10” refers to the version of the taxonomy, which is maintained and revised periodically by the World Health Organization (WHO) and “is the standard diagnostic tool for epidemiology, health management and clinical purposes.”Although conversion from the ICD-9 standard, which is still in use in the US, to ICD-10 is causing a major kerfuffle, it is important to note that ICD-10 has been around since 1990, and the WHO is poised to release ICD-11 in 2017. The 9th and 10th editions differ primarily in their specificity of coding, with the 10th differentiating between acute and chronic states of the same condition, left and right sided findings, initial and ongoing treatment, etc.The net result, of course, is that there are a lot more ICD-10 than ICD-9 codes to describe the full array of human disease and unfortunate mishaps, even though humans and the things that befall them have not gotten much more complicated since 1990. The current controversy arises from the fact that the Centers for Medicare & Medicaid Services (CMS) has mandated that hospitals and physicians submit their bills using the new codes as of October 1, 2014, effectively creating a new national standard for reimbursement determinations.The timing of the changeover means that doctors and hospitals must implement this as they simultaneously struggle with new quality mandates and IT meaningful use requirements. No wonder, then that the AMA has renewed its call for a delay in implementation, citing, among other things, a study (that it funded) that estimates that it will be financially “disastrous” for physicians to implement ICD-10. Although these are legitimate concerns, I think the objections that many physicians have to ICD-10 goes deeper than having to change some old habits of how we write our notes and drop our bills. I think it has to do with a fundamental disconnect about the role of documentation.As students and trainees, we were taught that the medical record is a tool for patient care. That it is intended to share information with other providers; or create a narrative over time, so that a patient’s progress (or lack thereof) can be observed; or provide a repository of reference information that may serve a future, as yet unidentified, clinical need. Yes, including enough information in our records for others to summarize into ICD-10 codes based on hospital documentation, or selecting the codes ourselves for office-based encounters, serves those ends.But the problem is that most clinicians believe that they can achieve the fundamental goals of clinical documentation without the constraints and complexity of ICD-10 coding. Here is the real problem. Just as I pointed out with EMRs, we have accepted a system that pays doctors and hospitals for “doing stuff.” Naturally, those paying the bills want to make sure that the stuff they are paying for is both appropriate and actually getting done, and have demanded that we document both. The language chosen for that exchange (we tell you what we did, and you pay for it) is an epidemiologic classification scheme that was not designed for that purpose. Is it any wonder that doctors hate it? Ira Nash is a cardiologist who blogs at Auscultation.

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

 

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New business models, more corporate VC & 8 other healthcare industry trends for 2014

December 16, 2013 by Deanna Pogorelc

In the first quarter of 2014, has PwC’s predictions come true? 

 

healthcareBased on healthcare industry predictions made last year by leaders and analysts, this year should have brought a re-evaluation of meaningful use (yep), a quantified self movement that would move mainstream(ehhh),  more M&A activity in the industry (definitely) and the emergence of interoperability as a competitive benchmark for providers (not quite yet?).

For 2014, analysts at PricewaterhouseCoopers are predicting that healthcare companies, especially drug makers, will have to make adjustments to their innovation and business processes to account for changes in ecosystem. We’ll also see more corporate venture capital, more employers exploring private health insurance exchanges and more price transparency.

Here are 10 predictions from PwC’s annual “Top Health Industry Issues” report:

  1. Industry changes will cause healthcare companies to reconsider their roles and business models. Many companies will look to expand their footprint and expand revenue streams (ex: insurers are acquiring providers and providers are entering the insurance business).
  2. Social, mobile, analytics and cloud tools have changed how health organizations interact with patients and with each other, which will drive new business models for healthcare companies.
  3. Companies will think more like startups — forcing experimentation and failing faster, cheaper and better.
  4. Demand for price transparency continues to grow and will be fueled by new health insurance exchanges. Cost-conscious companies will make transparency a priority in negotiations with health plans and providers.
  5. New technology has created rising demand for a digital-savvy healthcare workforce that can leverage technology to engage with patients.
  6. More employers will explore the potential of private exchanges. Sixty-five percent of surveyed consumers preferred that their employers offered three to five plan choices.
  7. In the face of precision medicine and a focus on specialty products, drug makers will need to embrace alternative clinical trial designs.
  8. Drug makers will prepare for new requirements to prevent counterfeit medications in the drug supply mandated by the recently enacted Drug Quality and Security Act. In 2015, drug makers will be required to begin tracking prescribed drugs in large bundles.
  9. Corporate venture capital will make up a bigger share of healthcare deals, filling in gaps left by retreating traditional venture capital firms. Partnerships between those two kinds of VCs will help corporations broaden their reach into start-up communities.
  10. States will continue to turn to managed long-term care solutions to help contain Medicaid costs. PwC estimates that 26 states will have Medicaid managed long-term care programs by 2014.

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Phil C. Solomon is a healthcare finance and revenue cycle BPO strategist with experience spanning two decades. Phil has expertise in the areas of revenue cycle optimization, clinical documentation, healthcare technology integration and BPO outsourcing. He is the publisher of Revenue Cycle News, a healthcare revenue cycle blog and is a featured speaker at many HFMANAHAM and AAHAM healthcare educational conferences.

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