Should Healthcare Abandon ICD-10?

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Hospitals and other providers are nearing the 18-month mark: That is, 18 months until they will be required to use ICD-10.

Last year, HHS finalized the new go-live date of ICD-10 for U.S. providers: Oct. 1, 2014. Over the past several years, a debate has raged throughout the country whether hospitals and physicians should make the transition to ICD-10 for their insurance claims and diagnoses. Most can agree that ICD-9 needs to be upgraded, but not everyone agrees on the path to get there.

ICD-10 opponents, such as the American Medical Association, have argued that ICD-10 will be costly and will burden physicians and other providers with a heap of new documentation requirements. In addition, the World Health Organization is roughly two years away from finalizing ICD-11, meaning ICD-10 — a product of the early 1990s — will soon be even more outdated. However, ICD-10 proponents say ICD-10 is a necessary step in getting to ICD-11, and ICD-10 must go forward to improve provider documentation.

While the ICD-10 versus ICD-11 debate heats up, one physician believes it is time to look at the situation from a different perspective.

Jon Handler, MD, is a board-certified emergency physician and the former director of emergency medicine research and informatics at Chicago's Northwestern University Feinberg School of Medicine. He is currently the chief medical information officer of technology firm M*Modal. Dr. Handler says one major stakeholder is being left out of the ICD-10 discussion: patients.

"The key thing here is physicians and patients don't have enough time with each other, and that is bad for patient care," Dr. Handler says. "Perhaps more importantly, something we are not measuring in this [transition to ICD-10] is the impact on patients not being seen."

Time to abandon ICD-10?
Dr. Handler says the physician-patient relationship is already strained through increased documentation and the infusion of electronic health records, and that has led him to pen an idea familiar to many: It's time for healthcare to abandon ICD-10.

"We have people literally dying in the emergency department waiting to be seen. Anything that makes my efficiency as a physician even less, so patients have to wait even longer for me to see them, it better be great. I don't see that ICD-10 does that," Dr. Handler says. "ICD-10 makes you document a whole bunch of details that are arguably important in 1992, but they are not that important now."

He adds that if payors or others want to move forward with ICD-10, that is certainly fine. It's the requirement on hospitals and physicians that is burdensome.

"My issue is making the provider side of the equation report data as ICD-10," Dr. Handler says. "Why force physicians — or EHRs, or coders, or anyone else on the provider side — to report the very same data in two different terminologies? Meaningful use stage 2 says I must report the problem in a problem list using SNOMED-CT, then recode the same problem as a 'diagnosis' in ICD-10? That seems nonsensical."

Solution
Instead, Dr. Handler suggests the healthcare system should either wait for ICD-11 — which many have argued would take several years after WHO releases the final version — or use compositional SNOMED. SNOMED, or the Systematized Nomenclature of Medicine, is one of the most specific databases of healthcare terminology, developed by physicians, and is the basis of the upcoming ICD-11 set. Further, compositional SNOMED, according to Dr. Handler, is when providers can string codes to describe diagnoses and is a "simple, better and more useful solution than ICD-10."

However, some say although SNOMED is the most comprehensive model for healthcare terminology and diagnoses, it doesn't work as well as a classification system because of how granular it is. Instead, ICD-10 should be used as the temporary stop-gap as the world formalizes ICD-11.

Dr. Handler says that is nothing more than an "unfounded myth." He says SNOMED can support a classification system because ICD-11 will be based on SNOMED — and its "granularity is what makes it uniquely suited for this purpose."

He also reiterates that all the effort expended on preparing for the 20-year-old ICD-10 system will make future transitions harder to handle, and he doesn't think patients should be casualties of the process.

"When you look at the costs, effort, training and impact on patients [of ICD-10], we've waited more than 20 years," Dr. Handler says. "We've waited until 2014 before we mandated the use of ICD-10, and less than one year [from then], ICD-11 is going to come up. Nobody is going to have the stomach to move to ICD-11, which everyone can agree is better."

Dr. Handler is not alone in his belief that ICD-10 should be scrapped for ICD-11 and SNOMED. Last year, five leading U.S. medical informatics experts wrote an article for Health Affairs arguing that healthcare may be better served by avoiding the drama surrounding ICD-10 and instead move toward ICD-11 and SNOMED. Like Dr. Handler, the authors wrote that ICD-10 is a major upgrade over ICD-9, but SNOMED and ICD-11 are the gold standards — and they are well within reach.

Many hospitals and physicians still have a long way to go in their ICD-10 transitions — in fact, most providers are still just getting started on their ICD-10 projects — but there are still some who have already invested millions of dollars in their ICD-10 projects. When asked if scrapping ICD-10 would affect those who have already put large sums of money toward ICD-10, Dr. Handler says any existing investments puts providers ahead of the game when it comes to ICD-11, and using SNOMED in the interim "should help their readiness even further."

However, he adds everything goes back to the most important stakeholder: patients. Providers are bound by the Hippocratic Oath, and he believes money invested in ICD-10 cannot trump potentially damaging effects of lost patient time.

"I'm not worried about physicians, payors, hospitals or any member of the healthcare system other than the patients we are honor-bound and mandated to serve," Dr. Handler adds. "I don't care how far along we are, if this is bad for patients, we should not do it."

What are your thoughts on ICD-10, ICD-11 and SNOMED? Should healthcare move forward with the transition to ICD-10 by 2014, or should it be scrapped in favor of SNOMED and ICD-11? Email your commentary to Bob Herman at bherman@beckershealthcare.com.

More Articles on ICD-10:

Hold Steady to ICD-10 Deadline, HIMSS Urges CMS
ICD-10: 3 Myths Debunked
ICD-10: A Bad Moon Rising?

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