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An ICD-10 critic goes over four myths that have been pushed by the coding set’s supporters and why he is against the transition
Have you ever stood near the tracks and listened to a train coming? When the train is far away all you can hear is the distant echo of the whistle. It’s easy to ignore. As the train gets closer you hear the engine and see the smoke. As the train comes to the station it becomes a thundering, screeching, hissing mass of steel.
If you are close enough, it can even startle you.
With an Oct. 1 start date imminent, the ICD-10 train is getting awfully close. Anyone harboring hopes of Congress rescuing us at the last minute is kidding himself. If your practice is not prepared, there are plenty of health IT companies out there who will gladly take your money to rescue you safely away from the tracks.
The supporters of ICD-10 -bureaucrats, health IT vendors, and medical academicians -have been assuring us this is for our own good. The era of big data in healthcare is coming, so they say, and ICD-10 is the perfect vehicle for collecting the rich, detailed data that will bring the next big age of medicine. ICD-9 is decades old and needs to be replaced by a system which can accommodate the advances in diagnostic acumen of recent years. Privately, these groups ridicule our misgivings and assume that we’ll complain for a while and just get over it.
Last February, Congress held hearings on ICD-10. This was supposed to be the last decision-making step before committing to the program. In reality, it was a choreographed farce designed to suppress the concerns of real-world physicians. The witnesses included two health IT vendors, two lobbyist groups, one academic physician, and two private practice physicians. All but one of the witnesses, the late urologist and president of the Medical Association of the State of Alabama, Jeff Terry, supported ICD-10. Most of the remaining witnesses either stood to benefit financially from ICD-10 or were insulated from its effects by the academic environment.
But there is more to ICD-10 than the propaganda peddled by supporters. Let’s look at some of the myths about ICD-10:
1. ICD-9 is outdated and needs to be replaced. The former is true. The latter is not. The structure of ICD-9 (five numeric placeholders) theoretically allows for 100,000 codes. ICD-9 could have been easily expanded by adding one or two placeholders and allowing letters to be used. This would expand capacity to over two billion codes. It would have allowed horizontal expansion (i.e., the addition of Ebola infection to the appropriate category -a favorite example of ICD-10 supporters) as well as vertical expansion (the breakdown of otitis media into left vs. right). This could have been done without rendering any ICD-9 codes obsolete.
2. ICD-10 based big data will improve patient care. ICD-10 supporters would have us believe that ICD-10 based data will lead to medical miracles falling from the sky. These utopian fantasies fail to consider the implications of the scientific method. Medical advancements come only from experiments based on hypotheses. Hypotheses dictate experimental design, including the methods and structure of data collection. Lacking any hypotheses, ICD-10 creates a one-size-fits-all data collection method for all fields of medicine. This makes absolutely no sense.
3. ICD-10 will improve quality of data collection. I almost believed this until I began to prepare my practice for ICD-10 months ago. Instead of a rational expansion of diagnoses I found -for my specialty, at least -a haphazard, nonsensical collection of codes created seemingly at random. I’m not talking about the “burned by water skis on fire” stuff we have all heard about. I discovered that every code related to ear pathology is obsessively divided into left ear, right ear, or both. Even “vertigo of central (nervous system) origin,” which by definition does not involve the ears, requires a choice of left or right ear! But other diagnoses -facial paralysis, head and neck cancers, sinusitis, and others -have no ICD-10 division by side. The diagnosis of vocal cord paralysis, in which the side of involvement has long been recognized to be clinically significant, is not separated by side. In fact ICD-10 has fewer codes for vocal cord paralysis than does ICD-9. Does this mean that ear disorders are more worthy of big data research than sinusitis, head and neck cancer and vocal cord paralysis? Who decided that? There is no way, for otolaryngology at least, that such a poorly designed coding system will yield any useful data. Don’t hold your breath waiting for any big data medical miracles.
4. Third-party payers are ready. Who are they kidding? Didn’t CMS claim that healthcare.gov was ready two years ago? How many test payments to providers were sent? There is no way to adequately test a system this complex before it goes live. Remember that CMS and private insurers have no risk on the table. If their systems “mysteriously” fail to pay claims, they benefit by keeping the cash they would otherwise have paid out. On the other hand, physicians will be unable to pay rent and make payroll if payments on claims are interrupted more than a few days.
The only rationale that explains ICD-10 is the desire of its supporters for a top-down, big government, centrally controlled healthcare system that regards doctors and patients as nothing more than cogs in the machine. The folks at the top fancy themselves worthy of conscripting the rest of us into becoming uncompensated data collectors. Doctors know that quality of care starts from the bottom, not the top -with a doctor, a patient, an exam room, and a conversation. At best, ICD-10 will be an expensive distraction that draws money and time away from patient care. At worst, it will paralyze the health care system.
Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice.
After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. A singer himself, many of his patients depend on their voice for their careers. Some are well-known entertainers.
Dr. Koriwchak has been working with information technology since 1977. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. In 2003 he became the director for ENT of Georgia’s EMR implementation project. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. He has been writing about health information technology since 2010 and has published on Townhall.com. He is one of the few physicians who writes his own computer code for his EMR.
In addition to his medical practice and health IT work he is also the Compliance Officer for his practice and the Vice President of the Docs4PatientCare Foundation. He is a co-host of the chat radio talk show, “The Doctor’s Lounge.”