June 3, 2015

Five Ways ICD-10 Helps Providers Reach Care Collaboration Goals

By Ken Bradley

Air travel isn’t as simple as it used to be, but if you proactively take advantage of some of the check-in perks offered, it can be a generally smooth experience. After check-in, all parties – the security staff, gate team, and flight crew – know who you are or at least have your pertinent information. If you’ve been pre-checked by the Transportation Security Administration (TSA), you’re approved to whisk through the security line with your shoes and belt still on. You and the flight crew know exactly where you’ll sit on the plane; you board early, and if you’re lucky enough to be in first class, the flight attendant can offer food and drinks right away.   

This coordinated experience only happens when the right people have the right data at the right time. Healthcare collaboration is equally if not more complicated and nuanced than air travel, and it’s also crucial to our daily lives. That’s why care coordination is central to healthcare reform: it can remove the fragmentation and communication barriers that impede efficiency, collaboration, and informed decisions.

Agreeing on care coordination’s importance is easy for providers; achieving it, however, is the difficult part. That’s where ICD-10 can help. At first glance, it may not seem directly related to the success of care coordination; however, ICD-10 can be a catalyst in five key ways:

1)  Providing specificity for today’s patient care and provider needs. When the U.S. healthcare system implemented ICD-9 in 1979, providers had different business and clinical data needs than they do today. On the business side, reimbursement models, patient billing, and technology have all advanced exponentially; activities such as claims submission require more detailed and complex data. On the clinical side, advances in medicine, more complex care needs, and the need for additional diagnoses to describe patient condition in greater detail have created the necessity for more breadth and depth in coding and documentation. In short, we’ve outgrown ICD-9, and ICD-10 is a good fit.

2)  Laying a foundation of standardized, comprehensive patient clinical data. Lack of detail in clinical documentation can lead to miscommunication, the need for repetition of tests, and requests for clarity – all of which can be costly. ICD-9’s narrower code set contributed to these issues, but ICD-10 allows everyone to describe clinical documentation with the same, much more specific code set. The language is more specific, accurate, and comprehensive. As interoperability provides a vehicle for sharing data, ICD-10’s standardization and thoroughness can ensure that all parties who access this data are able to get what they need.

3)  Promoting a better understanding of each constituent’s role in a patient’s care plan. An aging population, higher incidences of multiple chronic conditions, and a multilingual population all create more opportunities for miscues and a lack of understanding. ICD-10 allows for primary care physicians, specialists, therapists, and nurses to share the same detailed data; consequently, they don’t have to start at square one when consulting with patients for the first time. As a result, patients can have a more coordinated care experience while all parties can more effectively collaborate regarding treatment plans.

4)  Including advocates, researchers, and other parties who contribute to the advancement of healthcare. With ICD-10, healthcare collaboration can expand to include researchers and other constituents who need standardized yet detailed data. These constituents may not directly interface with patients during the care continuum; however, they can make important contributions such as medical advancements and protocol enhancements.

5)  Paving the way for more treatment accountability. Moving forward, one of the most challenging but important components of care delivery is patient involvement. Meaningful use (MU) has addressed patient engagement by promoting e-communications and the use of portals, but providers may need to involve patients on a deeper level. In particular, providers must find ways to improve patient adherence to care plans as value-based reimbursement becomes more prominent. Are patients filling and taking prescriptions? Are they scheduling and keeping referral appointments with specialists and therapists? In the future, the detail required by ICD-10 may assist in allowing providers to keep track of patients’ follow-up activities, follow-up results, and patient response to treatment plans to ensure that they are involved and following treatment recommendations.

Care coordination can only be achieved if healthcare’s silos and communication barriers are removed. ICD-10 plays an integral part in this by providing a data set that gives all parties the information they need. As interoperability becomes more ubiquitous, it also has the potential to create widespread variation in patient data. ICD-10’s standardization can allow us to reap the benefits of interoperability  and achieve a collaborative and coordinated care continuum that promotes greater efficiency and better outcomes.

About the Author

Ken Bradley is the vice president of strategic planning and regulatory compliance at Navicure, a provider of cloud-based healthcare billing and payment solutions.

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.

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