The Department of Health and Human Services (HHS) announced on January 15 the final regulation to replace the ICD-9-CM code sets now used to report healthcare diagnoses and inpatient procedures with the more advanced ICD-10 code set currently used in other nations. The final regulation will implement the ICD-10 code set two years later than HHS initially proposed: October 1, 2013.
The new timeline comes as welcome news to the industry, which feared that the original proposed implementation date of 2011 wouldn't give organizations enough time to prepare for the change.
Gloryanne Bryant, BS, RHIA, RHIT, CCS, senior director of coding and health information management (HIM) compliance for Catholic Healthcare West (CHW) in San Francisco, says CHW's recommendation was that an implementation date should have "at least three complete years, and because the implementation date would come out in January, we would foresee that moving [implementation] ahead would make more sense for everybody. So I'm pleased with the dates in the Final Rule."
Dan Rode, MBA, CHPS, FHFMA, vice president of policy and government relations for The American Health Information Management Association (AHIMA) in Washington, DC, agrees. "It certainly gives people plenty of time to implement and do the testing. On the other hand, it's not a reason to think that we can sit by for a while until we get closer to 2013. The concerns that we've raised about what has to be done over the next few years are still in front of us."
"We've got an extra year, so let's use it wisely," he says.
The delay in implementation did cause some mixed feelings. Jennifer Avery, CCS, CPC-H, regulatory specialist with HCPro, Inc. in Marblehead, MA, admitted to some excitement over the proposed 2011 date. "I'm sad in a way," she says. "This gives us a little more time to prepare. At the same time, I can't see why prolonging it will make it any better."
Nearly 30 years old, ICD-9-CM will run out of possible code combinations within a year. The present code set includes 17,000 codes, while ICD-10-CM includes more than 155,000 possible code combinations. This greater number of combinations allows ICD-10-CM to expand and keep up with new diagnoses and inpatient procedures. According to a statement on the AHIMA Web site, the United States is virtually the last industrialized country to adopt ICD-10-CM.
A second final rule issued concurrently with the ICD-10 final rule states the pending adoption of the X12 data standard, Version 5010, which includes updated standards for claims, remittance advice, eligibility inquiries, referral authorizations, and other administrative transactions that will take effect January 1, 2012. The current X12 standard, Version 4010/4010A1, cannot accommodate the use of ICD-10 code sets, making this change crucial. The second final rule also references Version D.0 for pharmacy transactions and NCPDP Version 3.0, a standard for the Medicaid pharmacy subrogation transaction.
Small health plans have an additional year to adopt 5010 and must be compliant with Version 3.0 by January 1, 2013.
This story first appeared as a breaking news item from HCPro, Inc.
Two European nations with public-private healthcare systems that provide near-universal coverage could serve as inspiration for U.S. policymakers debating healthcare reforms, according to a study released today by the Commonwealth Fund.
The healthcare policies of those two countries, Switzerland and the Netherlands, have created systems in which a mere 1% of their populations are uninsured because of an individual mandate that requires everyone to purchase health insurance. In contrast, 15% of the U.S. population is uninsured, according to Robert E. Leu, PhD, executive director of the department of economics at the University of Bern, Switzerland, and four colleagues, who wrote the study. (The individual mandate mirrors the system in Massachusetts, which requires health insurance and offers a program that connects citizens with health insurers taking part in the program.)
"The Swiss and Dutch health systems provide real-world prototypes for a regulated competitive model with multiple insurance plans, which many believe is the most likely route to universal coverage in the United States. Both countries' systems are in transition, with ongoing reforms focused on improving cost and quality performance. Tracking and understanding their experiences—both challenges and successes—offers potential insights for U.S. policymakers," wrote the authors of The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets.
Both European systems feature cost-containment measures, which result in lower administrative costs. The Swish and Dutch health systems spend 5% of healthcare costs on administrative costs, compared to an average of 7% for private U.S. insurers, the authors reported.
The systems also feature patient choice, broad access to care, low rates of care disparities, and premium assistance to those who can't afford it they added.
Karen Davis, president of the Commonwealth Fund, which supports independent research on health policy reform and creating a high-performance health system, said the two European nations should serve as "idea labs" for U.S. health reforms.
"There are examples of universal, comprehensive, high-quality, efficient healthcare systems that can show us the path to high performance," said Davis.
U.S. policymakers could learn from Switzerland and the Netherlands in four ways, according to the study:
The universal mandate requires every individual to purchase basic health insurance.
National standards require private insurers to offer a certain baseline services and protections.
Tight regulations of basic health insurance markets include requirements for open enrollment and community rating, which lead to lower overhead costs.
Risk equalization systems help reduce incentives for insurers to seek healthier enrollees.
As a result, the two European nations spend a lower percentage of their gross domestic product on healthcare than the U.S. and benefit from better health outcomes, including life expectancy, than Americans, according to the study.
The study's authors acknowledged that the Dutch system is still "a work in progress" because it was implemented only three years ago. The Swiss program, on the other hand, has been around since 1996. The authors wrote that some of the Swiss program's "shortcomings" are in the areas of risk adjustment and provider contract, which have been difficult to address, partly "because of split responsibilities for healthcare under Switzerland's federal system of government."
"This may have important implications in considering the right balance of federal and state responsibilities in health reform in the United States," the authors wrote.
A $112 million expansion of Shawnee Mission (KS) Medical Center will open to patients at the end of January. The six-floor, 265,000-square-foot wing gives added space to the emergency, intensive care, and cardiac departments, officials said. The critical-care services expansion, which is connected to the existing hospital, also will provide an updated, patient-friendly space, Samuel H. Turner Sr., the hospital's president and chief executive officer, said.
Animal rights group PETA has criticized St. Louis Children’s Hospital for using sedated cats to teach medical professionals how to perform an advanced life-saving technique on infants. PETA has asked the U.S. Department of Agriculture to investigate possible violations of the Animal Welfare Act because the group claims the cats suffer during the procedures and the hospital has failed to consider training tools that do not involve animals. Cats are used to mimic the airways of infants during intubation. St. Louis Children’s Hospital offers the instruction to doctors, nurses, and emergency workers as part of its Pediatric Advanced Life Support course.
Philadellphia-based Fox Chase Cancer Center officials have started telling employees that it would eliminate 75 jobs. Michael V. Seiden, MD, president and chief executive officer of Fox Chase, said a recent survey showed that because of the recession 20% of patients are cutting back on healthcare and forgoing procedures and recommended follow-up care.
A prominent spine surgeon and researcher at the University of Wisconsin received $19 million in payment over five years from spinal device maker Medtronic Inc., according to a senator who is investigating potential conflicts of interest in medicine.
The surgeon, Thomas Zdeblick, received the payments while helping Medtronic develop and promote a number of spinal products. Medtronic's $19 million in payments to Zdeblick from 2003 to 2007 went "greatly" beyond what was evident in disclosures he made to the university, Sen. Charles Grassley said in a Jan. 12 letter to the school's president.