June 22, 2015

ICD-10’s Role in Furthering Population Health: Why Intensive Education and Training will Promote Better Care Decisions

By Ken Bradley

When said in the company of clinicians, the term “ICD-10” may elicit grumbles or at least concerned looks – a somewhat understandable sentiment. Ranked as a top initiative in numerous provider surveys, ICD-10 requires detailed transition planning, multiple technology upgrades, and a considerable amount of training. The amount of information clinicians and staff must learn – especially the new code set and clinical documentation requirements – is substantial.

How substantial? Think back to your school days. How would you have reacted if your kindergarten teacher announced that the alphabet no longer had 26 letters, but 130, or if your high school chemistry teacher told you to memorize the periodic table – and by the way, it recently expanded from 118 elements to 590?

Certainly, the fact that ICD-10’s code set is five times larger than that of ICD-9 seems to present a steep learning curve. Fractures, for example, have 17,099 ICD-10 codes, as opposed to 747 with ICD-9, while poisoning and toxic effects will have 4,662 codes rather than 244. ICD-10’s learning curve isn’t solely due to the increase in codes, either; the new level of detail and specificity required in clinical documentation is just as significant. Diabetes documentation, for instance, must include the diabetes type, body systems affected, any complications or manifestations, and a secondary code if long-term insulin use is required.

While clinicians and staff may be wincing at the amount of new information they must be ready to put into practice by Oct. 1, 2015, ICD-10’s benefits to providers are undeniable. In particular, ICD-10 can further population health initiatives, the main focus of Meaningful Use Stage 3. The new code set and additional clinical documentation requirements, the very items creating a huge learning curve for providers, also can promote population health in four key ways:

1)  They ensure that patients with chronic conditions receive the best care, according to the latest research and protocols. ICD-10’s extra granularity will require physicians to document more specific and current protocols for patients in certain populations. Physicians also will be able to analyze patient data to identify trends in certain populations. As a result, they can study the effects of treatment protocols and identify patterns by criteria such as gender and age.

2)  They help identify patients at risk for chronic conditions. Beyond enhancing care for patients in certain populations, ICD-10 can help physicians identify patients at risk for diagnoses such as diabetes and hypertension. The precise nature of the code set can allow providers to set parameters to flag patients who fall into certain categories that indicate a pre-disease state. Physicians then can take preventive measures with patients, for instance focusing on diet and fitness initiatives to help lower blood pressure.

3)  They facilitate outreach and knowledge-sharing with other providers. ICD-10 will enable providers participating in accountable care organizations (ACOs) or other risk-sharing models to share comprehensive, thoroughly documented patient information easily. For that matter, any provider giving or receiving a referral will be able to exchange robust and standardized patient data, which will promote more informed care decisions and better outcomes.

4)  They result in the reporting of data regarding population health and effectiveness of treatments. Through ICD-10, researchers can more easily obtain data such as medication lists and orders, allowing them to study demographic groups, evaluate and enhance treatment protocols, and make other research-related improvements. Researchers will be able to get the data they need electronically and in a standardized, apples-to-apples format. Granted, we won’t reap the benefits of this type of reporting for several years, as researchers need time to develop a baseline with the new code set. Nonetheless, it will create unprecedented ease of use and access to patient data.

In addition to supporting population health, the depth and precision of ICD-10’s data has another helpful application: value-based reimbursement (VBR). With VBR, providers are frequently required to submit more comprehensive data than they have in the past. The more precise code set allows providers to increase the accuracy of claims. The expanded clinical documentation can help illustrate why physicians made certain treatment decisions, how much the patient’s health has improved, and what barriers may have stood in the way of this improvement. This more exact reporting can mean the difference between a paid or unpaid claim, and in the long run, it can have a major impact on the provider’s bottom line.

Essentially, ICD-10 is granular enough to allow for the documenting of nuanced patient conditions in much more detail, and that’s the very characteristic that can make transition planning a bit daunting or even tedious. The payoff is well worth it, though. In a recent Advisory Board Company survey, nearly three-fourths of responding provider CFOs agreed that managing the health of populations is critical. These CFOs indicated that they’re making huge investments to create an accountable care system so they can ensure better population health. Because ICD-10 can support a variety of population health initiatives by providing the necessary data, it can jump-start providers’ efforts without significant added costs (beyond the necessary investments for transitioning to ICD-10).

In the throes of a multi-hour, intensive educational session, trainees may question whether ICD-10 is worth it. Going back to an oversimplified but universal example, it’s like memorizing the alphabet, which lays the foundation for the lifelong enrichment obtained from reading for education and enjoyment.

Similarly, ICD-10 sets the stage for any number of population health initiatives that identify trends in certain demographics and disease states, validating clinicians’ longtime assumptions and advancing treatment protocols – and ultimately, it will improve the health of numerous populations for years to come.

About the Author

Ken Bradley, vice president of strategic planning and regulatory compliance and one of Navicure's founding members, is responsible for assessing markets, monitoring government regulatory requirements and providing competitive analyses to develop strategies and solutions that ensure Navicure and its clients continued success in an increasingly complicated business environment.

He is responsible for all Navicure industry transitions, including ICD-10 and 5010. He has given educational presentations and written several articles on 5010 and ICD-10.

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