The ultimate goal of all the reforms that are being passed left, right and center is reducing the cost of care while increasing the quality of care. And both, the meaningful use performance matrices and the added granularity of ICD-10 attempt to do the same. Let’s see how.
We all know by now that the attempt to electronicize (if there is such a word, if not, I should copyright it) the medical records is focused at reducing errors, sharing information, eliminating redundant procedures etc., all leading to reduction in cost and improvement in quality. So there is not much discussion there. Let’s now see if ICD-10 also meets these criteria.
One of the significant administrative cost factors associated with payer industry is the manual processing of claims. It is estimated that every extra percentage of pended claims (ones that cannot be auto-adjudicated) cost an average payer anywhere from $3 million to $5 million dollars a year. That may be chump change for some of the big names but is nothing to scoff at. Every single effort that reduces the manual processing helps. Today, most laminoplasty claims (for comprehensive myelopathy) are manually reviewed. With the advent of ICD-10 codes that provide the exact location of stenosis and identify compression syndrome, these claims can be auto-adjudicated, thereby saving administrative costs.
Let’s now talk about improved quality of care. The elimination of ‘V’ codes from ICD-10 and codification of factors that influence health, such as obesity, will surely provide for better wellness management programs. Similarly, the added granularity, such as the distinction between people with persistent asthma versus people without persistence, will enable better stratification of patients for disease management programs. These changes can only improve the quality of care.
Beyond the obvious congruence of objectives, there also are similarities in implementation efforts. When one is adopting EHRs for the purpose of achieving meaningful use, wouldn’t it make sense to add the ICD-10 logic in there at a small incremental cost rather than to leave the effort to a later day and incur another huge I.T. bill? In addition, both meaningful use and ICD-10 implementations impact not only the technology portfolio of the organization but also change the business process landscape significantly. Why incur the cost of two separate assessment exercises when one can do it at the same time at a much smaller incremental cost?
So, wouldn’t it be a good idea to merge the two initiatives that are currently being governed by two separate entities and are working on dissimilar timelines? Me thinks, it wouldn’t be a bad idea at all.
Rajiv Sabharwal is the chief solution architect in the Healthcare and Life Sciences unit at Infosys Technologies LTD. He can be reached at Rajiv_Sabharwal01@infosys.com.
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