In a little less than two years, hospitals and physicians must adopt a new coding system for services rendered. Advocates of this billing overhaul claim that it will improve care, yet, in reality, it is very likely the regulations will do more harm than good. The main difference from the current International Classification of Diseases, ninth revision (ICD-9), and the new ICD-10 slated for implementation Oct. 1, 2013, is the sheer volume of codes. ICD-9 currently uses 18,000 codes, while the newer version will have approximately 140,000 codes.
Much of this increase is a result of excess detail, not new disease discoveries. The new mandate has codes describing where patients were injured, ranging from opera houses to squash courts.
There is a code for “walked into lamppost” and “burn due to water skis on fire,” as well as 72 codes pertaining to birds. Yet do these codes need such inordinate detail and is it worth the cost?
The costs for cash-strapped hospitals will no doubt be substantial. James Swanson, director of client services at Virtusa, an IT services and consulting company, estimates the cost of conversion for big hospitals will be as much as $5 million. For large health care networks, it will be $20 million.
These billing changes epitomize the problems facing our nation’s hospitals and physicians trying to navigate a top-down regulatory climate that increasingly forces health care providers to divert more and more scarce resources away from patient care to tend to bureaucratic whims.
To satisfy these mandates, hospitals and physicians will have to devote valuable time, money and energy to learning and implementing this new billing system. This time would be better spent treating sick patients.
These regulations will also likely exacerbate already strict and extensive physician documentation requirements. This will further translate into less time at the bedside with patients.
While compliance with these new regulations will be onerous and frustrating for physicians, ultimately it will be the patients that suffer the most from diminished care.
The significant time and capital needed for ICD-10 adoption will likely accelerate the vertical integration of medicine. Doctors nearing the end of their careers may find it easier just to retire early rather than attempt to switch. As a corollary, these mandates and their associated costs could very well worsen access problems for patients desperately seeking care.
As health care costs continue to rise and reimbursements continue to dwindle, physicians and other providers need more flexibility from regulators to deliver high quality care at an affordable price.
Doctors need policymakers to foster efficiency and allow them to maximize scarce resources to better treat patients. This mandate does just the opposite. These 140,000 codes, replete with redundancies, intricacies and excesses, are not what the doctor ordered.
Congress and Health and Human Services should take another look at this regulation. As hospitals are simultaneously struggling to embrace “meaningful use” health information technology and trying to stay afloat in a business and regulatory environment that is rapidly changing under the health care overhaul law, is now really the right time to coerce hospitals and providers to adopt a sweeping billing and coding revamping as well?
While these billing changes may serve as fodder for late night comedy hosts and perhaps Jon Stewart will help the public by clarifying the complex nuances between the “bitten by turtle” and “struck by turtle” office visit, it is safe to say that it won’t be physicians, or, more importantly, their patients that are laughing.
Jason D. Fodeman, M.D. is an internal medicine resident at the University of Connecticut and a former graduate health policy fellow at the Heritage Foundation where he studied the etiology of rising health care costs.
