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ICD-10: Not quite the end of days


I couldn’t help but think about that turn-of-the-21st century vignette during the recent run-up to the October 1st implementation of ICD-10. I hereby boldly predict that by the time this column is published, the large majority of us will still be alive and in business.

The views expressed here belong to the author. They do not necessarily represent the views of Optometry Times or UBM Medica.

December 31, 1999, was supposed to be TEOD (the end of days), so my wife and I decided to buck up and face it head on. Near midnight, we sat together on the front stoop of our home and held hands as the rabble formed and started to converge. They were no doubt intent on stealing our stores of canned goods and toilet paper, not to mention the cash we’d withdrawn from the bank and stuffed under our mattress lest our life's savings dissipate into the Y2K ether. Their distant chants grew to a din, and the glow of their lanterns juked and jerked against the side of our brick rancher like a swarm of large, drunken fireflies.

I rubbed my eyes and looked again. The rabble slowly resolved into a rowdy gang of neighborhood children-our three sons among them-enjoying a rare suspension of bedtime protocol. They held their out-of-season, multicolored sparklers aloft like Liberty torches and ran harum-scarum through the streets as if tomorrow would never come.

But as the second hand of my wristwatch swept past 12, come it did.

More from Dr. Brown: Why you can't separate refraction from pathology

The end (of ICD-9) is nigh

I couldn’t help but think about that turn-of-the-21st century vignette during the recent run-up to the October 1st implementation of ICD-10. I hereby boldly predict that by the time this column is published, the large majority of us will still be alive and in business. It won’t exactly be “business as usual,” but that particular modus operandi, an all-American favorite, simply will not sustain our healthcare system for the long haul.

Sometimes we optometrists are so busy in our practices doing what we do well that we lose sight of our connection to the larger picture. We may not realize that some of the tasks that we are asked-OK, forced-to do may serve what some once called “the common good.”

Next: What's in it for you


What’s in it for you

I believe the conversion from ICD-9 to ICD-10 likely falls into that category. So “What’s in it for you?” Well, besides continuing to be paid, here are four domains where a few extra clicks of the mouse at the end of each patient encounter may improve our healthcare system in the decades to come:


1. Public health

Currently, the United States is behind other industrialized nations who have been using ICD-10 for years. The increased specificity of ICD-10 better captures information related to reportable public health diseases. Adoption of ICD-10 will facilitate improved real-time reporting and sharing of information related to potential public health threats. The United States, as a member of the World Health Organization, is obligated to be up to speed with international standards should such events occur.

Related: How our office prepared for ICD-10

2. Quality improvement and disease management

Although exactly how to measure quality will be an ongoing debate in the years to come, suffice it to say, American healthcare providers and organizations have for too long received a relative “free pass” compared to other industries when it comes to quality improvement and accountability. Medicine has changed greatly in the years since ICD-9 was adopted, and ICD-10’s increased granularity will better accommodate new medical technology and procedures. The data captured will help us to better understand complications of treatments, design better clinical algorithms, and decide which therapeutic approaches produce the best outcomes-and at what cost.

Don’t worry; we won’t be responsible for crunching all that Big Data-machines like IBM’s Dr. Watson are going to do it for us.

Next: HIT and reimbursement


3. Health information technology (HIT) and reimbursement

An upgrade to ICD-10 is an indispensable step in fully realizing the potential gains from HIT. ICD-10 data are better suited for electronic retrieval and mapping to Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), an international terminology system that captures practically every detail of a clinical encounter. This will produce better computer-assisted coding that will in turn increase consistency, efficiency, and accuracy of claims. Decreased fraud, as well as fairer and quicker reimbursement, should eventually follow.

Medical Economics: 20 bizarre new ICD-10 codes

4. Research

Try not to yawn; you wouldn’t be able to deliver that good patient care without it. ICD-10’s copious, finer detail will better enable medical researchers to discern previously hidden relationships and patterns across disease spectrums, leading to new medical procedures and treatments, as well as better evaluation of current ones. Improved public and population health are long-term goals of healthcare reform, and while such subjects may seem a bit dry and distant to the everyday concerns of many frontline practitioners, stronger bench-to-chairside bonds will produce macro dividends in these areas and lay the foundation for future generations to live productive and enjoyable lives.

Next: It's not just about us


It’s not just about us

That’s right-it’s not just about us and our provincial interests, i.e., the “here and now.” I understand the skepticism, though, and I’ve felt it myself. The clunky rollouts of Healthcare.gov and Meaningful Use haven’t exactly inspired confidence in federal healthcare mandates.

But I get a different sense on this one. Judging from online chatter and conversations with colleagues, I have a feeling that most of you are ready. Centers for Medicare and Medicaid Services (CMS), under pressure from Congress as well as organized medicine and other healthcare advocacy groups, has delayed the go-live date for two years now to allow providers and hospitals to better prepare. In addition, CMS recently established a one-year grace period in which providers will still get paid without using the nth degree of specificity as long as they use the correct coding family.

I suspect ICD-10 will be a lot like Y2K-some temporary snags and glitches here and there but not the complete meltdown many predicted.

Here’s hoping the conversion to ICD-10 is going well for you, colleagues. May concerns over TEOD, born of FUD (fear, uncertainty, and doubt), give way in future years to pleasant front stoop reveries and better healthcare for all.

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