Shots - Health News
3:40 am
Thu April 10, 2014

Doctors' Billing System Stays Stuck In The 1970s For Now

Originally published on Fri April 11, 2014 11:35 am

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 2014 NPR. To see more, visit http://www.npr.org/.

Transcript

DAVID GREENE, HOST:

Now, for doctors, hospitals and insurance companies, technology is changing the way patients and the care they receive are tracked. The complex information is boiled down into a system of codes - numerical codes for different illnesses, medicines and procedures. The current system is decades old and last week Congress put the adoption of a new medical coding system on hold. That delay could cost the health care system a whole lot of money. Eric Whitney reports.

ERIC WHITNEY, BYLINE: Behind the scenes, doctors, hospitals and other medical providers rely on a system of codes to track and pay for every procedure. Like an 813.02 for a broken forearm. The coding system is now four decades old, and JaeLynn Williams is seriously bummed out that its replacement has been pushed back for a year.

JAELYNN WILLIAMS: It's kind of like looking forward to Christmas, and it doesn't come.

WHITNEY: Williams is 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 her company, 3M Health Information Systems. Williams is passionate about the upgrade, since it'll give doctors, hospitals, researchers and insurance companies better data - data that will allow them to zero in on the best, most cost-effective treatments.

WILLIAMS: With ICD-9 there's only so much information that's captured with each code.

WHITNEY: ICD-9 only offers about 4,000 codes for procedures. ICD-10 has about 72,000. Without enough codes, Williams says, cardiologists, for example, can't differentiate between the dozens of different kinds of implants that are now commonly used to open clogged arteries.

WILLIAMS: So we can't use the data to analyze which implant had a better outcome. 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.

WHITNEY: For that, health care needs to upgrade to ICD-10, and everybody needs to do it at the same time for it to work. The White House has been trying to coordinate that for the last five years, but some doctors in smaller practices welcome the delay, like Eric Novack, an orthopedist in Phoenix.

DR. ERIC NOVACK: It's good news for us because there are enough challenges going on now with things changing in health care.

WHITNEY: For Novack, upgrading to the new coding system means all 10 doctors in his practice have to take a couple of weeks off from seeing patients to learn how to use it. And support staff needs expensive training, too.

NOVACK: We can put that on hold, and not have to worry about spending that big chunk of money at this time.

WHITNEY: Doctors and small hospitals are already struggling with big IT challenges beyond the ICD-10 upgrade, says Joe Lavelle, a health information technology consultant.

JOE LAVELLE: We've asked way more than we've ever asked from an IT standpoint, from a project standpoint, from a dollar standpoint than we ever had before. And 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.

WHITNEY: 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 retraining 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. JaeLynn Williams of 3M Health Information Systems worries that the delay will make upgrading harder in the future.

WILLIAMS: A conversation that I had with the director from a Beta 5(ph) hospital system, and she said to me I think the biggest issue with the delay, she goes, is the lack of trust that any new deadline will be held to.

WHITNEY: In a written statement to NPR, HHS says it's studying Congress' action, and will provide guidance on a new deadline for the coding upgrade soon. For NPR News, I'm Eric Whitney.

(SOUNDBITE OF MUSIC)

GREENE: And Eric's story is part of a partnership between NPR and Kaiser Health News.

(SOUNDBITE OF MUSIC)

GREENE: You're listening to MORNING EDITION from NPR News. Transcript provided by NPR, Copyright NPR.