October 30, 2014
With Halloween just around the corner, physicians may find it comforting to know that ICD-10 does not need to be on our list of scary things.
We've all heard so much about ICD-10, I think we're getting a bit numbed to the subject, and some of us may be having trouble separating fact from fiction. Of course, many doctors are -- and should be -- concerned about running a business (namely, their practice), and they wonder how all this will impact their bottom line. But I want to focus instead on ICD-10 as it impacts the clinical side of our profession.
[Provider readiness toward ICD-10 has stalled. Is anyone surprised? Read ICD-10 Survey: Procrastination Rules.]
Hey, docs -- like it or not, we are being watched. Hospitals, HMOs, insurance companies, and other payers are profiling our clinical practices, our resource utilizations, and our outcomes. They are creating and using scorecards on individual physicians, not just hospitals and healthcare systems. And they're doing all this while using a coding system that was put into place in 1979. It's antiquated, out-of-date, and inadequate to codify modern medical practices. I like to think of it as trying to writing to write a PhD dissertation using third-grade grammar. In order to fully code what we do, along with all the conditions and co-morbidities of our patients, we must update our methodologies -- and that means ICD-10.
I recently had to complete ICD-10 training for cardiology in order to maintain privileges at my hospital. Now, the color slides certainly were delightful, but there was little in the training that could not have been accounted for by two simple phrases: "Due To" and "Manifested By."
Physicians absolutely must be educated about the principles of proper and complete clinical documentation. Why is there a gap between the notes we write to communicate doc-to-doc and those needed by the hospital to properly code and bill the encounter? And how do we close that gap? Proper training on how to write such notes will provide everything needed for helping with ICD-10 compliance.
I want to add a new acronym to our list: M.E.A.T. For every condition you mention in a clinical note, you should indicate whether that condition was M-Monitored, E-Evaluated, A-Assessed, or T-Treated. This will help in getting full and proper credit for conditions that go into risk-adjusted reimbursement models such as Medicare Advantage. There's a very important topic we'll need to leave for another day.
So, physicians who are vegetarians may have a little trouble swallowing the concept of M.E.A.T., but omnivores should have no problem. Remember -- payers are watching! We are being Monitored. We are being Evaluated. We are being Assessed. But Treatment is easy. Start to use "Due to." Start to use "Evaluated by." Take a big bite of M.E.A.T. And get on board with ICD-10.
If the world wasn't changing, we might continue to view IT purely as a service organization, and ITSM might be the most important focus for IT leaders. But it's not, it isn't and it won't be -- at least not in its present form. Get the Research: Beyond IT Service Management report today. (Free registration required.)
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