We arrived at 7:15 this morning for the HIMSS/WEDI ICD-10 National Pilot Program meeting. Mark Lott described the logic behind the testing plan and stated, “any test that doesn’t find things is a waste of time.” The intent of the pilot is to identify issues and share results, testing metrics, and lessons learned. The national pilot will utilize and share a standard approach for testing. The test scenarios are based on real de-identified medical records that are dual-coded and peer-reviewed. This is a multi-stakeholder (payer, clearinghouses, providers, etc.) collaborative that will provide end-to-end testing asynchronously.
Next, Ian Bonnet, vice president of exchange execution for Wellpoint, shared results of its Early Adopter Testing:
- DRG variances were much higher than projected. For example, they expected a 13 percent DRG variance in the Nervous System, but actually experienced a 27 percent variance. In the Digestive System, they expected an 8 percent DRG variance, but actually experienced a 20 percent variance. In muscular, they expected a 7 percent variance and experienced an 18 percent actual variance.
- MDC shifts were not expected, but did occur.
- Providers who outsourced coding had a 2 percent higher DRG variance.
- Time-to-code IP claims decreased from three to five claims per hour to one to two claims per hour.
- Coding errors included invalid codes, decimals in incorrect places, and coding not following coding conventions (i.e., first listed coding rules not followed). This lack of data quality caused increased rejected and pended claims.
Bonnet concluded by saying that Wellpoint is planning to test with another 40 to 50 additional providers.
Later at a CMS briefing, Marilyn Tavenner, the Acting Administrator for CMS, said that we should be proceeding full steam ahead on ICD-10. CMS is 100 percent committed to moving it forward and will not delay any further.
“Necessity to Reform”
The HIMSS afternoon keynote speaker was President Bill Clinton. While Clinton did not address ICD-10 specifically, he did make several observations about our current national situation and healthcare more specifically. First, he stated that our borders are no longer walls, they are nets, which means we live in highly unstable (e.g., financial crisis) and dangerous times. He pointed out that we rely on systems to live: water, transportation, schools, etc., and that at some point in the life of every nation, a system gets “long in the tooth.” It is too expensive to continue with the outdated system.
He went on to say that it is human nature to want to extend the life of these systems, but we can’t keep defending an unsustainable status quo. It’s what you do that matters in these gritty, tough times and often we need to sacrifice to change. Clinton said that our healthcare system represents 17.8 percent of our gross domestic product. No other country is that high—France’s is 11.8 percent, Germany’s is 11.5 percent and has great outcomes. Canada’s is 11 percent. The difference between 11 percent and 17 percent is one trillion dollars per year. He stated that he read a study recently that claimed that 30 percent of every healthcare dollar is wasted. “What lies before us is the necessity to reform” our health care system, he continued.
The goal of the healthcare system should be to be the best without bankrupting America. That means that the growth in healthcare spending year-over-year should mirror inflation. Achieving the social benefit of the Accountable Care Act relies on how the ACA is implemented, which is in our hands.
Information technology and having access to data is very important. Everyone is aware of the population shift and the Baby Boomers retiring and entering the Medicare ranks. It is very important that we have the data and understand the costs of providing care and can provide millions of people data that empowers them to affect the industry.
Clinton said that the sequencing of the human genome cost the American taxpayer three billion dollars, “and it was worth every penny.” He believes that over the next 10-year period, healthcare will create jobs, prosperity, and a new way of delivering care, sharing data, and being transparent. He said we should be optimistic, and there is nothing that we cannot fix.
Wednesday was a day of powerful speeches and great information at HIMSS. As storms approach the northeast, we are hopeful that our travels home tomorrow will not be delayed, as we miss our families and want to return to work with the fresh perspective and energy for change that we gained at HIMSS.
Cindy & Howard
About the Authors
Cynthia D. Fry is vice president of revenue for Catholic Health East, a multi-institutional, Catholic health system located in 11 eastern states from Maine to Florida. Cynthia leads the revenue management initiative which is designed to improve operational performance through synergistic efforts across CHE’s various entities and is also CHE’s executive sponsor for ICD-10.
Howard Walker is director of revenue cycle systems and projects, is the Catholic Health East ICD-10 program manager. Prior to CHE, Howard was a manager at Accenture in the healthcare practice. Howard has his bachelors from Villanova and his M.B.A (May, 2013) from Penn State.
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