Insights on Healthcare Reform and ICD-10 Transition

This post comes to you from the Healthcare Payments & Policy Conference, called HCON2011. This is a two-day conference continues through today with its focus on the healthcare payments environment and policy trends. You can read more about it in the June 2011 HIMSS Business Edge newsletter.

Following yesterday’s opening keynote, I moderated the panel: ICD-10 Transformation Impacts in the Marketplace. Panel members were:

As the conference brochure described, the panel reported “key findings from the recently held HIMSS G7 meeting with focus on payment processing challenges caused by ICD-10 transformation at point of service.”

Questions addressed by the panel included:

• With many more codes being planned, how will the technology ‘ingest’ these and how will they impact the revenue cycle?
• What are sustainability plans passed the Oct. 13 industry ‘go live’ date?”

These panel members shared their thoughts on why they, and other members of the healthcare community, focused on the ICD-10 transition during our April G7 meeting  to convey a single and focused message: mobilize now and be ready for the new ICD-10 coding guidelines.  You can read more on this topic in the HIMSS G7 ICD-10 Advisory Report.

The panel received many questions from the audience, but I ran out time and couldn’t take them all. One of the interesting ideas from the session came from a person who was in the public health domain. She indicated there might be an opportunity, as a result of ICD-10, to drive better consumer behavior.

How? Let me see if I can adequately retell.

Ian Bonnet, from Wellpoint, indicated language barriers clearly exist between ICD-9 and ICD-10, and that these language barriers can’t all be resolved with a cross-walk. Wellpoint also believes dictating new policies won’t foster the resolution.

However, ICD-10 has provided a great opportunity to create collaboration with providers so that focus groups and other panels can help to define the intent behind the codes. By mutually agreeing to these “linguistic anomalies” going from one to the other, it creates a set of shared expectations that won’t be as divisive as getting hit with denials.

From this dialogue, Lori Sickelbaugh from Wake Forest Baptist Health Center suggested this type of activity was helping the hospital to reconsider its mission — from disease management to enablement of healthy lifestyles and wellness.

Next,  the population health official in the room focused on creating broad programs that help the “health illiterate” groups to become better engaged with their healthcare…many of whom aren’t on the Internet and don’t have the common tools that folks typically think of (computers, Internet).

At this point, I jumped in and discussed banking (of course) and why banks had to figure out how to move folks from keeping their dollars underneath mattress to opening up accounts…and then doing ATM banking…then online banking, and now, mobile banking. To do this requires overcoming linguistic barriers and generational barriers in use of technologies, etc.

Lori Sickelbaugh took the floor once again and said, “Yes, we actually put a drive-through window at our hospital because a lot of people still won’t put a stamp on a piece of mail and send the bill in; they want to drive in and make a payment.”

What a crystal clear example of what healthcare organizations often fail to understand – they must meet the customer where he or she is. It’s something that requires rethinking, and clearly, if we are to gain the level of success that banks have, we need to think like banks do.

In other words, how do we holistically (and with segment sensitivity) move consumers from inappropriate health habits to better living and wellness?

I was very pleased to connect ICD-10 implementation and healthy living. This connection has caused an entire hospital system to review its mission from providing care for disease to proactively engaging the community with mobile clinics, diabetes testing in malls and more.  In other words, we must meet consumers where needed and provide the tools to transform their internal business model and idea of “healthcare.”

We enjoyed a full discussion, but had to stop to make way for the next session, just as I thought it was getting good…go figure! I look forward to meeting with this great group of panelists and attendees again at our next Medical Banking Institute at HIMSS12.