Updated on: November 25, 2014

Applying Transparency to ICD-10

By Mark Spivey
Original story posted on: November 21, 2014

Greg Adams, FHFMA

“Transparency” is a term typically reserved to apply to government entities or picture windows – not ICD-10.

But Greg Adams, vice president of the consulting division of Panacea Healthcare Solutions, says it applies to that, too.

“You may have heard about price transparency since there has been a lot of publicity around this topic with a recent study by the Catalyst for Payment Reform showing that two-thirds of states received a failing grade for their healthcare price transparency laws – while another seven states squeezed out a D grade,” Adams noted, adding that only two states, Massachusetts and New Hampshire, managed an A grade.

“While the emphasis has been on price transparency,” he added, “I think of transparency in a broader perspective than just price.”

In its simplest terms, Adams explained, transparency in any market, the healthcare market included, is the ability to have sufficient information to compare the value of products.

“For healthcare this has recently been defined as quality over price,” he said. “Having this type of transparent information allows consumers to compare providers. In an economic sense, markets cannot function efficiently without transparency. If a buyer cannot distinguish the differences in price and quality between suppliers, then there cannot be an efficient market.”

As the U.S. healthcare industry amounts to something of an inefficient model, historically it has been “difficult, if not impossible” to compare hospital prices and quality, Adams added. But he also said the industry seems to be nearing a tipping points as patients become more responsible for a larger and larger portion of their healthcare bills.

“I believe transparency will happen, (and) it will happen fast. And it will be defined as price and quality – in other words, value,” Adams said. “We all agree that ICD-10 is connected to clinical documentation improvement, and clinical documentation improvement is connected to quality through the accurate coding of the medical record. And since quality is part of the value equation, remember that value equals quality/price.”

The bottom line?

“Coding in ICD-10 will result in a better reflection of the quality of care provided and improve transparency in healthcare,” Adams said.  

About the Author

Mark Spivey is a national correspondent for ICD10monitor

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