ICD-10: The First
Opportunity for Physicians to Take Back Control of Healthcare in 30 Years
Ever since 1969 when Richard
M. Nixon signed the HMO Act, physicians’ and providers’ authority for care
decisions and control over reimbursement has been steadily eroding, almost to
the point of non-existence. The power of the insurance industry, which has
taken over that mantle, notwithstanding, what has really allowed this to happen
is the provider’s almost total lack of data with which to justify reimbursement
levels or evaluate and prove effectiveness of care within specific disease
categories or for specific conditions. ICD-10 and the use of EMR’s will give
providers the ability to take back control of healthcare. The question is: Will
they take it?
There has never been a lack
of data on procedures or care administered. The lack of data has been largely
on the side of the diagnosis coding. The overwhelming use of unspecified and
vague diagnoses from superbills and EMR pick lists, that are designed to allow
for quick generation of codes for billing and the doctors aversion to the time
it takes to document, has left a database that shows low acuity level patients
that do not justify the levels of care being administered. In addition, vague
diagnostic information makes it virtually impossible to discern in any large
scope what treatment protocols work effectively with what specific conditions.
ICD-10 and EMR’s, if used
properly, will give physicians their own database of information with which to
justify what they have always known but could not demonstrate. Their patients
are sicker! Continually submitting unspecified uncontrolled type II diabetes on
the same patient for years after their condition had progressed to renal
failure, neuropathy, and retinopathy has been the norm. Doctors that change
those habits will have the means to justify proper reimbursement levels and
will be able to see within their own data what specific disease categories, and
conditions respond best to what treatments.
Healthcare reimbursement for
physicians is moving back toward diagnosed and performance based reimbursement.
HMO’s are now being called ACO’s (more on this in my next blog). Physicians
that do not fully utilize ICD-10 and document the true acuity levels of their
patients are laying an undervalued foundation for their future reimbursement.
Those that seize this opportunity, document well (which is actually easier in
ICD-10, another blog) and report the true acuity level of the patients they see
will be taking back control of their future and their industry as insurance
companies transfer risk and care authority back to them in the ACO model. This
is the first true opportunity I have seen in 30 years for providers to start
taking back healthcare.
Using ICD-10 effectively will
help get us to real value and evidence based medicine faster. This is the realm
of the Doctor not the insurance company. Physicians resisting ICD-10 do not see
the big picture. It is akin to pushing away a life preserver when you are
drowning because it is not the one you like.
The real good news is that
the patients will ultimately benefit more than anyone and that is what
physicians are really all about. Doctors
get on board now. It is far easier than you have been lead to believe to take
advantage of this great opportunity.
