Payout neutrality using the new MS-DRGv26 is a debate...simulate your payments now
Frankly speaking, if such a thing is possible, then ICD-10-CM/PCS codes and the ICD-9-CM codes are no different. Then why is US healthcare moving for ICD-10? Obviously, not just to upgrade from its precursor ICD-9 or to position itself better in the international health space. I guess, the correct answer is to use ICD-10 as a catalyst for mitigating the long standing concerns- 1.) compromised quality of care and 2.) escalating healthcare cost. ICD-10's clinical granularity promises better care but, its inherent ability to identify the wider disparity in severity (and presumably resources) than the ICD-9 predecessor is "the power" to make payouts/reimbursements more tailored and precise.
In this context, the CMS initiative to keep the MS-DRGs intact irrespective of being induced by ICD-9 or ICD-10 is highly debatable (from ICD-10's financial incentive perspective). Why? Let me site two examples-
a. The ICD-9 code 39.31 (SUTURE OF ARTERY) today maps to MDC 5, MS DRG 252-254. Post ICD-9 to 10 conversion this source code having 195 target codes (as per GEM) will be in the same MDC 5, but surprisingly in a different DRG, i.e. 237-238.
b. Post 2013, ICD-10 codes OB717DZ or OB718DZ will derive DRG 165. But obliging to the CMS MS-DRG conversion principle if any one intends to map those ICD-10 codes back to ICD-9, OB717DZ and OB718DZ ICD-10 codes will get mapped to ICD-9 code 96.06, Other Intubation Respiratory Tract, which will be then altogether a different DRG (DRG 203).
With many such empirical data, it's evident that maintaining payout neutrality in ICD-10 world is going to be real challenge & arduous task. In a nutshell there is an inherent need to split the MS-DRGs acknowledging the clinical depth of the new ICD codes. Moreover, once CMS has collected a year or two of ICD-10-based data the landscape of DRGs is sure to change considerably.
It is never a business wise decision to wait till 2015. Right away one has to initiate some intelligent payout simulation and make some payment changes and that's obvious - such as when the ICD-10 codes clearly distinguish minor and major procedures and it doesn't make sense to lump them together now that they know exactly which procedure was performed by the provider(because of the increased specificity in ICD-10-PCS).