ICD-10 to Have Minimal Impact on Inpatient Payments Initially
It will take at least two years for the transition from ICD-9 to ICD-10 to have a substantial impact on Medicare inpatient Medicare Severity-Diagnosis Related Groups (MS-DRG) hospital payments.
It will take at least two years for the transition from ICD-9 to ICD-10 to have a substantial impact on Medicare inpatient Medicare Severity-Diagnosis Related Groups (MS-DRG) hospital payments.
That is the conclusion of new research published in the Journal of the American Health Information Management Association.
"The transition from the ICD-9 version of the MS-DRGs to the ICD-10 version of the MS-DRGs will have a minimal impact on aggregate payments to hospitals (-0.04 of a percent) and on the distribution of payments across hospital types (-0.01 to -0.06 of a percent)," the study's authors write. "Although the transition from the ICD-9 version of the MS-DRGs to the ICD-10 version resulted in 1.07 percent of the patients being assigned to different MS-DRGs, overall payment increases and decreases due to a change in MS-DRG assignment essentially net out."
The essential leveling of payments is likely because the new ICD-10 MS-DRG's are a replication of the ICD-9 version, the authors said.
"Since there is no substantial database of records coded in ICD-10 available, there is no way of recalibrating the MS-DRG payment weights to correspond to ICD-10 optimized MS-DRGs. Hence the MS-DRGs cannot take full advantage of ICD-10 until there is enough ICD-10 data available to allow the recalculation of the MS-DRG payment weights."
However, the authors, from 3M Health Information Systems, also said the relative status quo should not be assumed to be long-lastingas more ICD-10 data is created, recalibration of payments using the more granular ICD-10 codes will be easier to accomplish.
"Realistically, the earliest an ICD-10 optimized version of MS-DRGs can be implemented is FY2018. This means that there will be two years of ICD-10 coded data available before an ICD-10 optimized version of the MS-DRGs is implemented," they wrote.
The delay, they contend, will allow for the evaluation of changes in coding practices between the two ICD versions, thereby minimizing opportunities for up-coding in the new optimized ICD-10 MS-DRGs.
The authors created a simulated ICD-10 database using 2013 Medicare Provider Analysis and Review data to enable their analysis.
The full study is available here.
That is the conclusion of new research published in the Journal of the American Health Information Management Association.
"The transition from the ICD-9 version of the MS-DRGs to the ICD-10 version of the MS-DRGs will have a minimal impact on aggregate payments to hospitals (-0.04 of a percent) and on the distribution of payments across hospital types (-0.01 to -0.06 of a percent)," the study's authors write. "Although the transition from the ICD-9 version of the MS-DRGs to the ICD-10 version resulted in 1.07 percent of the patients being assigned to different MS-DRGs, overall payment increases and decreases due to a change in MS-DRG assignment essentially net out."
The essential leveling of payments is likely because the new ICD-10 MS-DRG's are a replication of the ICD-9 version, the authors said.
"Since there is no substantial database of records coded in ICD-10 available, there is no way of recalibrating the MS-DRG payment weights to correspond to ICD-10 optimized MS-DRGs. Hence the MS-DRGs cannot take full advantage of ICD-10 until there is enough ICD-10 data available to allow the recalculation of the MS-DRG payment weights."
However, the authors, from 3M Health Information Systems, also said the relative status quo should not be assumed to be long-lastingas more ICD-10 data is created, recalibration of payments using the more granular ICD-10 codes will be easier to accomplish.
"Realistically, the earliest an ICD-10 optimized version of MS-DRGs can be implemented is FY2018. This means that there will be two years of ICD-10 coded data available before an ICD-10 optimized version of the MS-DRGs is implemented," they wrote.
The delay, they contend, will allow for the evaluation of changes in coding practices between the two ICD versions, thereby minimizing opportunities for up-coding in the new optimized ICD-10 MS-DRGs.
The authors created a simulated ICD-10 database using 2013 Medicare Provider Analysis and Review data to enable their analysis.
The full study is available here.
More for you
Loading data for hdm_tax_topic #care-team-experience...