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.

Visit the SMA Ready10 webpage for software to help you begin the transition to ICD-10.

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