plus $5 to $40 million per year in lost productivity.
The estimated benefits over a 10-year
period could amount to nearly $8 billion from more accurate payments for new procedures; fewer miscoded, rejected, and improperly paid claims; better un- derstanding of the value of new proce- dures; improved disease management; and better understanding of health care outcomes, the report concluded. However, an earlier study by the Rob- ert E. Nolan Co. painted a far less rosy picture. The Nolan report, issued in Oc- tober 2003, concluded that implementa- tion costs could run between $6 billion and $14 billion over a two- to three-year implementation period. Nolan also concluded there would be a short-term degradation of medical knowledge over a three- to five-year pe- riod because of the disconnects between ICD-9-CM and ICD-10-CM and ICD-10- PCS; a likely backlog of claims and pay- ment delays; and an increased potential for fraud and abuse. The report also concluded that
promised benefits of ICD-10, including reduced medical review of claims, im- proved fraud and abuse detection, and improved ability to negotiate contracts between providers and payers “are un- certain and unproven.” Dr. Spain says the cost of ICD-10 im-
plementation for a small practice such as his likely will be $2,000 to $3,000. “For larger practices, I think the cost could be substantial,” he added. “If you’re in a larger group practice of 20 or 30 doctor — or even 10 to 12 doctors — you could easily spend $5,000 to $10,000 getting employees trained, getting materials up- graded that you use in the office, and, on top of that, you may face some up- grade fees from your software providers.” And, he says there almost certainly will be a loss of productivity while physi- cians and office staff learn the new code set.
“For people who are in it at the last minute and haven’t really prepared, I think there could be some serious pro- ductivity drops,” he said. “If you spend five, six, eight minutes looking up codes for every encounter, you’re not used to
Harvesting the benefit Still, there are some benefits doctors likely will see in the long run. Ms. Da- vis says there is a potential for increased cash flow to a physician’s practice be- cause of the ability to more accurately code for each diagnosis, thereby possi- bly allowing the physician to bill for a higher level of service. She says the added specificity and documentation of each encounter likely also will give physicians the data they need to defend them against health plan ranking systems.
“Health plans use claims data to rank physicians,” she said. “ICD-10 should al- low physicians to more accurately reflect the medical conditions of the patient population that they’re treating, thereby being useful in defending themselves in rating programs.”
Ms. Buckholtz adds that there will be no financial benefits for physicians in the short term but they should see a return on investment in just a few years. “ICD-10 is dollar driven, so if we use
it correctly and in the way that it needs to be used and code the highest level of specificity … we can make cases to sup- port the clinical necessity of treating our patients,” she said. “Doctors should be able to qualify for financial incentives easier. “But that’s going to evolve over a few years,” she added. “It’s not going to hap- pen overnight. And it’s all going to re- quire the proper use of ICD-10.”
Getting started
Even though physicians still have nearly two years to get ready for ICD-10, the experts say now is the time to get start- ed. But Ms. Spector says it is a daunting task.
“In general, what we’re seeing is that physicians feel overwhelmed by all this and other things they’ve got on their plates right now,” she said. Version 5010 of the HIPAA administrative transaction standards had to be implemented by Jan. 1, 2012, while physicians also are trying to deal with achieving meaningful use
February 2012 TEXAS MEDICINE 31
doing that. That’s pretty quickly going to eat into one or two visits per day.”
of electronic health records, developing accountable care organizations (ACOs), and more. Ms. Spector says there is some con- cern that older physicians may choose to retire early rather than go through the trouble and expense of implementing all these new requirements. And, she is con- cerned a lot of practices won’t be ready to meet the Oct. 1, 2013, deadline. “From what I’ve been hearing, I don’t know if practices have put enough work into this at this point,” she said. “And there is concern that since they haven’t put enough work into it now that they are going to be behind when the dead- line arrives.”
Ms. Davis and Ms. Spector say that some physicians and other providers think there will be another reprieve from the implementation date. But they say that is unlikely because so many other new regulations and innovations in the health care system, such as ACOs, will rely heavily on the data provided by ICD-10.
“That’s wishful thinking that there will
be a delay. Everything we’ve been hear- ing out of CMS is that there won’t be a delay,” Ms. Spector says. “ICD-10 is a fundamental piece to a lot of the other things going on so they can’t delay hav- ing this implemented.”
Ken Ortolon is senior editor of Texas Medicine.
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68