One of the benefits of increased uptake of electronic medical records often cited is the ability for government to “mine” massive amounts of health care data. By analyzing raw data about disease prevalence, testing, treatments, and resource utilization, the hope is that increased efficiencies may be found within the system, allowing us to cut costs and decrease the overall health care costs in this province.
The New Brunswick Medical Society has published a predicted savings of $6,000,000 (presumably per year) through wider adoption of EMR systems. How and where this savings will be realized is not clear. Assuming that the quoted figure is based on proper research and statistical analysis – and not just pulled out of a hat – it’s no wonder people are starting to take notice of EMRs.
The generally held belief is that in order for data to be “mined” effectively, clinical diagnoses need to be coded, most likely using the International Classification of Disease method. The one in use at this time is known as ICD-9, but ICD-10 is coming, and its planned introduction in the United States is creating quite a stir.
Why? Well, while ICD-10 coding may be a dream for the bean counters, it is being widely panned by the people of the front lines of medicine. It includes some 68,000 individual service codes, and for each clinical encounter, physicians south of the border will be required to figure out which code applies, or they won’t get paid for the work they do.
It can go to ridiculous extremes, as you are about to see.
Take a look a the following explanation, extracted from the excellent blog KevinMD.com:
ICD-10 will accelerate the demise of private practice
First, medical practices and hospitals must know and have all of these 68,000 codes readily available to add to the medical record in order to bill correctly and hope to be paid. One more distraction for physicians, aside from all of the daily distractions of electronic records. When physicians pay more attention to their computer screen or tablet than to the patient, guess who suffers? This is the reason why texting and driving is illegal.
Second, electronic medical records (EMRs) must be able to incorporate these codes into the exam or procedure report. Are all EMR vendors up to speed on these codes? Will their system upgrades work as advertised? Or will they work as well as the Healthcare.gov website? And if the codes don’t work, physicians and their practices don’t get paid. Yet landlords, employees, and utility companies still want to be paid.
Third, will the insurance companies recognize each of these new 68,000 codes, correctly match them to billed procedures, and promptly pay the providers? If I treat a patient with macular degeneration with a monthly dose of a $2000 drug, I now bill a single code, which insures I will be paid. Under ICD-10, there will be 20 codes, specifying which eye(s) and severity, which allow payment. Will every insurance company have each of these codes in their computers? Will it recognize each code? Remember that these are the same insurance companies that don’t even know who hasactually paid their insurance premiums.
The American Medical Association announced that ICD-10 implementation will cost three times as much as originally estimated. The “costs of raining, vendor and software upgrades, testing and payment disruption” could be $225,000 for a small medical practice and over $8 million for a large practice. How do medical practices of marginal profitability absorb these costs? With physician reimbursement rates set to grow at only1/2 percent per year over the next five years, far below the true rate of inflation, of close to 10 percent, the financial writing is on the wall. This will accelerate the demise of private practice, already underway due to Obamacare. When ICD-10 is eventually implemented, “The doctor is in” may be a phrase of historical interest only.
Brian C. Joondeph is an ophthalmologist and can be reached on Twitter @retinaldoctor.