Healthcare

What happened?

Has the healthcare industry become far-sighted overnight with regards to HIPAA mandates? Don’t think so. They are still worried a lot more about the upcoming enrollment season or next year’s contract negotiations with in-network providers.

Has the new administration opened another of its pockets, specifically for this transition? Not really. Last I checked there were no Billions (for that matter even Millions) of dollars allocated for ICD10. Neither does the administration think that transitioning to ICD10 is something that should be incentivized. After all, hasn’t everybody else accepted this cost of doing business and moved on?

The possibility of pride (US being the last developed country using ICD9 codes) over-riding the potential high-value expense associated with the transition can definitely not be the reason. Neither can pure and unadulterated urge to improve the quality of care without any accompanying financial motives.

So, what could it be?

Yours truly believe that the slick ones in the industry (especially those encumbered with mundane IT support works) have figured out the ultimate escape clause. Why transition 20 legacy systems to the new coding scheme, when one can benchmark the cost-of-20-individual-transitions against the cost of consolidation + cost of say 2-3 transitions. Huh!! Let me think. I guess, if you can give me a lower total cost for consolidation (rip and replace or virtual, who cares) and transition with an added bonus of reducing my going-forward MIPS (or FLOPS or whatever IBM is calling it these days) and reduced labor to support consolidated platform…sure, why not. And in the process if I look like the knight in shining armor for having adopted a HIPAA mandate without undue fuss and within stipulated time frame, even better. Giddy Up!! I still have the “Dallas influence” on me despite having left the city 15 years ago.

As recent as a year ago, NPI mandate was attempted to be solved using a quick and dirty crosswalk solution. Though its success is questionable but so is its failure. So why not attempt something similar for ICD10 also? Granted those are two drastically different beasts, but I am sure the differential in costs between a basic crosswalk and a comprehensive remediation solution, will sway the staunchest of the purists, especially under today’s economic scenario.

Why not create a reverse map from ICD10 to ICD9 codes (the one to many issue will be resolved that way) and continue to let run the existing systems as is? So why not too many upper echelon people talking about it (I hear about the crosswalk being the panacea, once in a blue moon)? The reason is that they see a much bigger play here, more of an opportunity than a necessity: Bring forward the decommissioning dates for identified-sun-set apps, externalize and consolidate the business rules for applications that perform similar functions and retire most of the redundant ones, remediate the leftover apps for ICD10, and voila, you have a nice streamlined IT shop with a lot of surplus labor capacity to devote to all those projects that you could not pay attention to over the last several years. That is, till the ICD11 transition at least.

This, ladies and gentlemen, is the primary reason, at least so I believe today. It was not my thinking 7 months ago when we started on the iTransform path. Heck, I did not think on these lines even 3 months ago, but more and more I talk to people in power at various US payers and more I try to read between the lines (or hear between the sentences, whatever), the more I get convinced that the thing that is attracting the top-tier IT folks is more to do with consolidation and streamlining rather than just managing a mandate.

That brings me to the titular question… so is it a healthcare meltdown scenario? I guess, if you don’t take any remedial action and wait for your platform vendor to provide a nifty little upgrade version that not only plugs the ICD10 related gaps within the vendor application but also streamline your associated business process, then sure, it is a potential meltdown situation for you. But most, if not all, execs are thinking on the aforementioned lines of ‘treat it as an opportunity, especially given the extended date’ and that definitely does not sound like ‘Meltdown’ to my untrained ears. Stressful, yes. Requiring urgent and careful planning, yes. Diligent and focused execution, yes. Meltdown, no.