ICD-10 overview: Is your EHR ready to help with the transition?

ICD-10, the new coding system that the providers should be compliant by October 1, 2014, is a challenge; needless to say this is a truism. ICD-10 is worrisome for everyone, let alone the big healthcare organizations. ICD-10 has 68,000 codes, as opposed to the 13,000 in ICD-9; this requires expertise, time and trainings at same time. The EHR vendors will be required to meet the standards of criteria and implement it smoothly.

Many codes of ICD-10 are built on the existing codes of ICD-9. With ICD-10 translation support tools, directly built in your EHR many of the ICD-9 codes can be used to navigate using translation tools. EHR transition from ICD-9 to ICD-10 is an arduous challenge for the developers too, because the EHR system is filled with bugs and removes them from requiring provider’s feedback.

The headache lies in providers who will have to familiarize themselves with new ICD-10 codes and standards. With the EHR system, they will still need extensive training for themselves and their staff in order to deliver. If the provider’s biller makes a mistake in coding, the result will be no revenue in shape of denied claims. EHR provides tools to allow easy cross over; tools from both ICD-9 and SNOMED are provided inside the EHR to eliminate the need to memorize the differences between codes as the system will adjust to itself. The compliance will be managed automatically.

How easy will the EHR make the transition from ICD-9 to ICD-10 for you? In fact, let’s exaggerate a little bit; it will be very easy at least easier than your current workflow. Not knowing the code for a specific condition you will be able to far more range of diseases with just a few clicks and with minimal effort through the use of advanced search built in tools. Searching through the system helps you identify the code, and ensures they are apposite and billable.

A comparison of Fee-for-service and Pay-for-Performance payment models

Payment models are the basis by which healthcare industry works. At the end of the day, providers need to get paid in order to thrive. But which model is successful? Which model delivers results needed by the healthcare system as a whole?  

Pay-for-performance is a relatively new concept gaining fame. The idea is to improve care by improving quality and reducing costs. Fee-for-service is a model aimed at delivering as much services as possible in order to generate more money. 

In a Fee-for-service (FFS) model the charges for each service provided to the patients are different. In essence, this model helps physicians make more money as providers are able to provide a host of services in a package. In this model quality suffers, as it is primarily not the focus of the physician, but at the same time revenue generation flows. FFS has caused increase in medical costs over the period of time. Government is not in favor of this model as physicians are able to misuse the system, and strategically wants to phase it out. Everyone wants money; likewise, physicians are lured to make more money through this structure which should be the secondary aim of the doctor, patient’s quality care should always come first. 

Pay-for-performance (P4P): Quality of service pays the provider, in this model. The criteria in terms of quality increase the efficiency of the provider; and, likewise, incentives are based on the quality of work done by the physician. This is a method by which physicians remain vigilant. Accountable Care Organizations follow this model, and according to a report by Oliver Wyman, a leader in global management consulting, 14% Americans are now being served by an ACO. ACOs through coordinated care delivery system not only provide high quality care, but are able to save huge costs by sharing their resources among different healthcare facilities falling under ACO. Finally, the share of costs saved, is divided among healthcare providers.

By all means, P4P model is better than FFS model. Government’s focus to move away from the old model is the proof. With the use of EHRs P4P can be made easier and possible. The shift in adoption is slow but with the use of technology this can be made significantly faster especially with those spicy incentives that are being introduced for the shift.