Doctors' Billing System Stays Stuck In The 1970s For Now
For doctors, hospitals and insurance companies, all the complexities of medicine get boiled down into a system of codes.
These codes are used to track and pay for every procedure you can think of. There's 813.02 for mending a broken forearm, and 800.09 for treating a concussion. There's even 960.0 for being hurt in an "unarmed fight or brawl."
But this coding system is now four decades old. The codes were scheduled to be upgraded in October, but last week Congress delayed the switch.
JaeLynn Williams, for one, is seriously bummed out. "It's kind of like looking forward to Christmas, and it doesn't come," she says
Williams and her company, 3M Health Information Systems, are helping about 5,000 hospitals upgrade from the old coding system, called ICD-9, to the new one, ICD-10.
It's a $100 million project for 3M Health. Williams is passionate about the upgrade since it will give doctors, hospitals, researchers and insurance companies better data — which will allow them to zero in on the best, most cost-effective treatments.
"With ICD-9 there's only so much information that's captured with each code," she says. ICD-9 offers about 4,000 codes for procedures. ICD-10 has about 72,000.
Without very specific codes, cardiologists, for example, can't differentiate between the dozens of different kinds of implants now commonly used to open clogged arteries, Williams says, "So we can't use the data to analyze which implant had a better outcome," she says. "We can't use the data to determine which implant results in the shortest recovery time. You won't be able to use the data to understand which implant had the best long-term success."
For better research, health care needs to upgrade to ICD-10, and everybody needs to do it at the same time. The White House has been trying to coordinate the shift for the last five years, But some doctors in smaller practices welcome the delay, like Eric Novack, an orthopedic surgeon in Phoenix.
"It's good news for us because there are enough challenges going on now with things changing in health care," he says.
For Novack, upgrading to the new coding system would have a significant impact on the ability of the 10 doctors in the practice to take care of patients efficiently. And support staff needs expensive training, too.
"We can put that on hold, and not have to worry about having to spend that big chunk of money at this time," he says.
Doctors and small hospitals are already struggling with big information technology challenges beyond the ICD-10 upgrade, such as implementing electronic health records in the first place, says Joe Lavelle, a health information technology consultant.
"We've asked way more than we've ever asked from an IT standpoint, from a project standpoint, from a dollar standpoint," Lavelle says. "Their vendors haven't provided them updated software, so they can't start testing or planning, and they just haven't gotten started or pushed their vendors to get started."
But big hospitals and insurance companies have invested heavily in being ready to switch to ICD-10 six months from now.
They've already sunk millions into re-training staff, and many have started testing the new systems in anticipation of the October, 2014 deadline. After all, the Department of Health and Human Services was calling that date solid as recently as February.
And HHS didn't ask Congress for the delay, it was part of a political compromise. Congress pushed back the deadline, which many doctors wanted, at the same time it passed a major Medicare bill that doctors didn't like.
3M's Williams says her clients worry the delay will make upgrading harder in the future. "I think the biggest issue with the delays is the lack of trust that any new deadline will be held to," she says.
In a written statement to NPR, HHS says it is studying Congress' action, and "will provide guidance" on a new deadline for the coding upgrade "soon."
This story is part of a partnership between NPR and Kaiser Health News.
Copyright 2021 NPR. To see more, visit https://www.npr.org.