February 2, 2015

It’s Always Something


As I’ve read and listened to so many passionate arguments for and against ICD-10, it has always seemed that there is more to the story than some think. How can a simple coding change, albeit a whopper, create such angst, animosity, argument, and adversarial positions? Why are so many physicians so opposed to something that may improve quality of care?


I’ve come to the conclusion that it’s not just ICD-10 that has created this resistance among some physicians. It is the current environment in which they practice and the never-ending new challenges coming at them – all of which comes along with costs in time, money, and personal sacrifice. It’s the piling on that is the issue, not simply the coding changes.

Physicians have faced more significant changes in the past two years than in any other comparable period; ownership of practices, regulatory requirements, insurance market changes, increasing medical necessity requirements to provide covered services, electronic health records, myriad audits, big data, and the list goes on. The “too much, too fast” concern has been clearly expressed by many organizations, many times and in many venues.

Unfortunately, there has been no slowdown in the healthcare industry, no pauses to allow taking a breath and no evaluation of whether what we are doing is working. Keeping all of these balls in the air is proving to be an impossible task for some. So, what does one of the most current surveys tell us about how physicians view their professional surroundings? The Physicians Foundation Biennial Survey, most recently published in September 2014, provides an in-depth look into the thoughts and plans of more than 20,000 physicians from all specialties and states. Some key findings that relate directly to implementing ICD-10 (and any other new requirement) explain how difficult new mandates could be for many physician practices.

It’s About Time

For one thing, there is no time. Eighty-one percent of physicians reported that their practice was overextended or at full capacity, a significant increase over the results of the survey in 2012. At the same time, 44 percent of respondents are taking or planning to take various steps that will decrease patient access or mitigate regulatory burdens. Perhaps more importantly, and more frustrating to physicians, the very things that were supposed to allow them to be more efficient have had the opposite effect. Forty-six percent of respondents reported that electronic health record (EHR) implementation decreased their efficiency, while 24 percent indicated that EHR decreased their quality of care. Also, 47 percent believe that EHR has detracted from their patient interactions. Although 32 percent of those responding said quality was improved, only 24 percent thought efficiency was increased. A tiny 4.6 percent suggested that patient interaction was improved. Overall, 20 percent (or more, in some studies) of physician time is spent on non-clinical paperwork.

Today’s Unpleasant Medicine

A few thoughts on medicine: although 2014 showed positive improvement over 2012, more than 55 percent of physicians reported feeling negative about where medicine is today. A healthy number reported feeling more positive, but they were still in the minority. Based on the responses, it seems that there is significant resentment about perceived interference and insertion of too many rules and regulations into the doctor-patient relationship. That is certainly compounded by the ever-increasing paperwork and non-clinical burdens being imposed on physicians. I think author Dean Koontz said it best: “one man’s idea of perfect order is another man’s chaos.”

ICD-10: Just One Thing

Some thoughts on ICD-10: although there are no statistics in this survey specific to what type of education, training, tools, or assistance the physicians have received relevant to ICD-10, the findings involved all specialties and sizes of practices, as well as those that are independent and hospital-owned.  About half of respondents reported believing that ICD-10 will cause “severe administrative problems” in their practices. Only 11 percent of the responding physicians believe that ICD-10 will improve diagnosis and/or quality of care. Three-quarters believe it unnecessarily complicates coding, and 38 percent believe it will create increased exposure to liability and penalties. If this survey truly represents our nation’s physicians, we have a major disconnect between the practice of medicine and the world of statistics, analytics, coding, and definitions of quality and payment. If we assume the survey does accurately represent physicians, is this an impossible chasm to bridge before Oct. 1, 2015? How do we reach these physicians to help them? Can we help them? Is ICD-10 just one more thing on the “it’s always something” system overload? What unanticipated aftershocks are possible?

As I reflect on this survey and what we have heard physicians say for several years, I find that I think many have been so focused on the successful implementation of ICD-10 and how to get there that we have failed to fully consider the challenges and frustrations many are facing every single day. ICD-10 can’t be segregated into a neat little package from all the rest of the requirements they must face in their practices and with their patients. 

If this survey is an accurate representation, fully half of our nation’s physicians told us loud and clear how disruptive they believe ICD-10 is going to be. We need solutions and we need them quickly.

Let’s open the dialogue today. Let’s really listen to the physicians and what they are telling us about their practices, not just about ICD-10. They have many other things on their plate because it truly is “always something.”

Then maybe we can find a workable solution to the problems so that Oct. 1, 2015 will be minimally, not maximally, disruptive. 


To view the survey online, go to http://www.physiciansfoundation.org/uploads/default/2014_Physicians_Foundation_Biennial_Physician_Survey_Report.pdf


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.
Holly Louie, RN, BSN, CHBME

Holly Louie is the compliance officer for Practice Management Inc., a multi-specialty billing company in Boise, Idaho. Holly was the 2016 president of the Healthcare Business and Management Association (HBMA) and previously chaired the ICD-10 Committee. Holly is also a national healthcare consultant and testifying expert on matters related to physician coding, billing, and regulatory compliance. She has previously held compliance officer positions in local and international billing companies. Holly is a member of the ICD10monitor editor board and a popular guest on Talk Ten Tuesdays.