Why evidence-based regulation is critical: 3 challenges facing physicians’ practices after ICD-10 Implementation

Thursday, October 1, 2015 marked the official implementation date of ICD-10. Physicians, hospitals and other providers across the country are transitioning from working with 13,000 medical billing codes to 68,000 codes.

According to policymakers, the intent of ICD-10 is to document diagnoses, symptoms and procedures in a more comprehensive and accurate manner. Yet, this process and implementation will likely generate significant and unintended consequences, including: unhelpful administrative and regulatory burdens; increased time and resource allocation; and, most critically, diminished time spent with patients.

According to The Physician Foundation's 2014 Biennial Physician Survey, 50 percent of America's doctors indicate that ICD-10 implementation will cause severe administrative burdens in their practices. In addition, this significant undertaking is further exacerbated by inefficient EMRs and the 2,167 quality metrics listed by the federal agency Healthcare Research and Quality, with which physicians need to contend.

In healthcare today, there is a large push toward practicing evidence-based medicine. This means that as physicians we will deliver care that has been proven successful through widely accepted research. This makes sense; we want to provide care that is effective and in the best interest of the patient. What we need today is evidence-based regulation. ICD-10 is the latest example of government intrusion that will not foster better quality of care.

We need to formulate smart policies that enhance quality of care and do not generate a heap of unintended, harmful consequences. Every regulatory change in medicine should be able to answer these two questions: "How does this help doctors help patients?" and "How is this helping our patients get healthier?" Physicians are rarely included in regulatory conversations, a problem my colleagues from the Physicians Foundation highlighted in a recent Forbes article.

Regardless of our feelings about ICD-10 and its value, physicians must transition in order to maintain their medical practices and care for patients.

Below are the top three challenges I feel physicians practices face after ICD-10 implementation:

  • Understanding new coding guidelines – some specialties are simpler and others are more complex. This transition is not simply a matter of switching from ICD-9 to ICD-10; it requires learning new rules about how procedures and diagnoses are coded and ensuring all relevant parties are fully aligned. CMS has allowed a one-year grace period for claims submitted incorrectly—and rightfully so. It will take at least a full year for a new system to be fully understood.
  • Ensuring ICD-10 implementation does not cause slowdowns and inefficiencies in the office. Seventy-five percent of physicians believe ICD-10 will unnecessarily complicate coding, according to the Physicians Foundation 2014 Biennial Physician Survey. Physicians' practices need to keep in mind that other industry partners may not be fully prepared for the transition (e.g., insurance companies, EMR systems). Physician offices must consider these challenges and develop solutions to maintain a consistent workflow.
  • Managing potential financial impact of implementation. According to the American Health Information Management Association (AHIMA), the estimated costs for ICD-10 for a small practice to be prepared for the conversion to ICD-10 is in the range of $1,960-$5,900. A small practice is defined as three physicians and two impacted staff such as coders and / or front desk / back office personnel. Beyond the upfront costs, physician reimbursement will likely be impacted due to coding confusion.

In my mid-sized practice, we have identified a physician leader to educate the practice on the new codes and changes we must be aware of as an OBGYN practice. We have turned to our state medical society for resources and guidance. Now, we must wait to see the impact this change will have on our practice and patients.

Joseph Valenti, MD, is a Board Member of the Physicians Foundation. Dr. Valenti is a board certified obstetrician and gynecologist with 17 years of private practice experience. He is the founding senior partner of Caring for Women, PA in Denton, TX.

The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.

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