Healthcare Economy

Let's begin with the ultimate goal of all the reforms that are being passed left, right and center... Reduce the cost of care while increasing the quality of care. And both, the meaningful usage performance matrices and the added granularity of ICD10 attempt to do the same. Let's see how.

We all know well by now that the attempt to electronicize (if there is such a word. If not, I should copyright it) the medical records is focused at reducing errors, sharing information, eliminating redundant procedures etc., all leading to reduction in cost and improvement in quality. So there is not much discussion there. Let's now see if I10 also meets these criterions.

One of the significant administrative cost factor associated with payer industry is the manual processing of claims. It is estimated that every extra percentage of pended claims (ones that cannot be auto-adjudicated) cost an average payer anywhere from 3 to 5 million dollars a year. That may be chump change for some of the big names but is nothing to scoff at. Every single effort that reduces the manual processing, counts. Today, most of the Laminoplasty claims (for comprehensive Myelopathy) are manually reviewed. With the advent of I10 that provide the exact location of Stenosis and identify compression syndrome, these claims can be greatly auto-adjudicated, thereby saving administrative cost.

Let's now talk about improved quality of care. The elimination of 'V' codes from I10 and codification of factors that influence health such as obesity, will surely provide for better wellness management programs. Similarly, the added granularity, such as the distinction between people with persistence asthma versus people without persistence, will allow better stratification of patients for disease management programs. These changes can only improve the quality of care.

Beyond the obvious congruence of objectives, there are similarities in implementation efforts also. When one is adopting EMRs in any case for the purpose of meaningful usage, wouldn't it make sense to add the I10 logic in there at a small incremental cost rather than to leave the effort to a later day and incur another huge IT bill?

In addition, both meaningful usage and I10 implementations impact not only the technology portfolio of the organization but also change the business process landscape significantly. Why incur the cost of two separate assessment exercises when one can do it at the same time at a much smaller incremental cost.

So, wouldn't it be a good idea to merge the two initiatives that are currently being governed by two separate entities and are working against dissimilar timelines? Me thinks, it would not be a bad idea at all.