ICD-10s future and Population Health

US Congress-NightWidely publicized and taking the industry quite by surprise was how someone could slip in the delay of ICD-10 regulatory go live to 2015 through voting on repealing the Sustainable Growth Rate reduction of 24% (aka Doc Fix”).

Now that both the Senate and the House have voted to delay ICD-10 (with no mention of it during the 5 hour debate), the question of gaining better data by capturing, storing and analyzing medical information electronically that could have facilitated better quality of care, improved population-based knowledge and the development of new tools for medicine is up in the air. Project sponsors and stakeholders seem divided about next steps, though being able to complete their planned work effort, now with more flexibility, seems wise as it will be one less “priority #1” that they have to deal with in the future and the costs of transitioning would be less hectic and possibly lower cost if done now.

A few examples are patient medical records, radiological images, clinical trial data, FDA submissions, human genetics and population data. ICD-10 – CM will be instrumental in supporting the healthcare data that is growing exponentially from digitizing existing data and generating new forms of data. HHS and CMS e-health initiatives are key drivers providing pathways for the appropriate people to get access to the data – the problem lists, medication lists, lab orders that were performed and the computer assisted codes (CAC) generated out of all the narrative generated output.

ICD‐10‐based segmentation opportunities assess the health needs of each segment of the patient population with increased accuracy, enhancing each member’s experience by providing additional touch points and addressing gaps in care. ICD‐10 allows advanced engagement, compliance and care management efforts to result in healthier members. Informed allocation of resources for clinical intervention enables significant cost reduction.

ICD-10 will also feed scientific healthcare data for research and population health management. Over time, ICD-10 data would provide more information on disease progression and treatment efficacy. From a high-level perspective, ICD-10 will generate more detailed healthcare data and a greater flow of specific and viable data that improve medical communication, which could contribute to advanced disease protocols and clinical pathways. Predictive modeling is now gaining ground more than ever and while the retail industry has been able to understand their customer’s buying patterns and behavior, so too will healthcare organizations with their patients and payers with their members. ICD-10 data has the potential to yield more information about the quality of care and, as a result, this improved data will support better a understanding of complications, better design of clinically robust algorithms and better accuracy of being able to track of patient outcomes as the codes better describe the gravity of a patient’s illness.

A healthcare leader mentioned reminded me today about a conversation that we had just before the end of last year which was that the delay in ICD-10 was one of the reasons why many healthcare IT executives wait until the last minute to get things accomplished as many times, it does not pay to be a leader in completing your initiatives, and, due to the instability of the political and regulatory climate, being an early adopter of either technology or regulatory mandates doesn’t always pan out. ICD-10 is more reflective of the scientific advances that have occurred in medicine in the last 30 years. ICD-10 has been out since 1994 and we need to adopt it sooner rather than later. Hundreds of millions of dollars have been spent around the country to get ready by October 1st, 2014, which has not seemed to have been understood by the political community in Washington, D.C. While I don’t offer any political viewpoints or advice, I would, on this topic, ask if any of the Congressional leaders understand the immensity of their vote and the sunk costs by healthcare organizations around the country to be ready by October 1st, 2014.  Healthcare advocacy has now taken on a different dimension. Ask your elected officials to Congress why they voted for this and I would like to see what they say. It would be good to find out who added the ICD-10 delay into the final document.


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