This is the moment we feared for years. Tomorrow, when we show up at work, ICD10 will be live. Doctors protested the roll-out because it is onerous with no improvement granted to patient outcomes. So on the eve of ICD10, we need to wonder how this occurred despite much protest.
The ICD10 coding system is much more complicated than its predecessor ICD9. Was the change truly necessary? For patient care, no. Nothing changes in the care we give our patients, except the time we take from them to actually code their diagnoses. The benefit of the ICD10 system is clearly not to physicians or other healthcare practitioners. In fact, this added stress and time consumer may prove to be a detriment.
Who stands to benefit from our enslavement to ICD10? In this coding, much more information, or data as the industry calls it, can be gleaned from billing records. When charges are submitted to third-party and governmental insurance agencies, they will be able to harness much more data about patients and what ails them. Despite the public’s cry for privacy protection, pleas to derail ICD10 implementation fell on deaf and uncaring ears. Those in favor of ICD10 cite improved patient outcomes. How is unclear. Doctors treating patients do not look to a bunch of codes to determine treatment plans. We look to the patient, not their data. This is a basic concept taught early in medical school: treat the patient, not the numbers. Clearly, the government and third parties are not interested in that thinking. They want data, your data. They will use it to decide what medical care you are allowed and they will over-ride what care you receive. ICD10 codes serve no clinical purpose, it is merely a tool used for billing purposes. Until tomorrow when all data is set loose for purposes yet unseen.
There is a quality improvement push from the government. It does not take into account how a patient is actually doing but how their numbers are doing. If their LDL cholesterol or blood pressures are at a governmental acceptable level, all is well and doctors can expect to be paid for their services. If the patient is doing well clinically, but their LDL jump because of that 3 week cruise the patient took and ate all day, the government will not approve and doctors will be docked in pay. This is the beginning of quality based care, not as determined by actual quality but by governmental agencies. More and more doctors are changing to concierge models of practice and I think this is going to drive more in that direction. This is a true disaster as we are already seeing difficult times in patients accessing the healthcare system in a timely fashion.
On the eve of ICD10, I ponder whether I will be paid or some IT disaster will strike. I ponder whether the data abstracted from ICD10 will be used against me in the future. And I ask, who will benefit from ICD10 because it is clearly not doctors or patients? Do we really want our data being evaluated by governmental agents for their own unseen purposes?
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