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ICD-10 Deja Vu – End of Grace Period

Posted on June 8, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I recently came across this article by Aiden Spencer about the possibility that ICD-10 could still cause issues for healthcare organizations once the grace period ends. Here’s what he suggests:

The CMS grace period was a welcomed relief because it meant practices would still be reimbursed under Medicare Part B for claims that at least had a valid ICD-10 diagnosis code. This meant physicians and their staff could get up to speed without worrying about taking a huge hit to their revenue stream.

With only five months left until the grace period ends, industry experts are predicting that an ICD-10 crisis might still be coming for some providers. Will you be one of them? Are you currently implementing quality medical billing software, or will the system you’re using fail come October 1st?

This certainly feels like what we were talking about last October when ICD-10 went live. A bunch of fuss and very little impact on healthcare. Are we heading for another round of fear and anxiety over the end of the ICD-10 grace period?

My gut tells me that it won’t be a bit deal for most healthcare organizations. They’ve had a year to improve their ICD-10 coding and so it won’t likely be an issue for most. This is particularly true for organizations who have quality HIM staff that’s gone through and done audits of their ICD-10 coding practices to ensure that they were doing so accurately.

I saw one stat from KPMG that only 11 percent of healthcare organizations described the ICD-10 implementation as a “failure to operate in an ICD-10 environment” with 80% finding the move to ICD-10 to be smooth. I imagine we’ll have a similar breakout when the ICD-10 grace period ends. Just make sure you’re not part of the 11 percent.

How Much Patient Data Do We Truly Need?

Posted on November 23, 2015 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As the demands placed on healthcare data increase, the drive to manage it effectively has of course grown as well. This has led to the collection of mammoth quantities of data — one trade group estimates that U.S. hospitals will manage 665 terabytes of data during 2015 alone — but not necessarily better information.

The assumption that we need to capture most, if not all, of a patient’s care history digitally is clearly driving this data accumulation process. As care moves into the digital realm, the volume of data generated by the healthcare industry is climbing 48% percent per year, according to one estimate. I can only assume that the rate of increase will grow as providers incorporate data feeds from mHealth apps, remote monitoring devices and wearables, the integration of which is not far in the future.

The thing is, most of the healthcare big data discussions I’ve followed assume that providers must manage, winnow and leverage all of this data. Few, if any, influencers seem to be considering the possibility that we need to set limits on what we manage, much less developing criteria for screening out needless data points.

As we all know, all data is not made equal.  One conversation I had with a physician in the back in the early 1990s makes the point perfectly. At the time, I asked him whether he felt it would be helpful to put a patient’s entire medical history online someday, a distant but still imaginable possibility at the time. “I don’t know what we should keep,” he said. “But I know I don’t need to know what a patient’s temperature was 20 years ago.”

On the other hand, providers may not have access to all of the data they need either. According to research by EMC, while healthcare organizations typically import 3 years of legacy data into a new EMR, many other pertinent records are not available. Given the persistence of paper, poor integration of clinical systems and other challenges, only 25% of relevant data may be readily available, the vendor reports.

Because this problem (arguably) gets too little attention, providers grappling with it are being forced to to set their own standards. Should hospitals and clinics expand that three years of legacy data integration to five years? 10 years? The patient’s entire lifetime? And how should institutions make such a decision? To my knowledge, there’s still no clear-cut way to make such decisions.

But developing best practices for data integration is critical. Given the costs of managing needless patient data — which may include sub-optimal outcomes due to data fog — it’s critical to develop some guidelines for setting limits on clinical data accumulation. While failing to collect relevant patient data has consequences, turning big data into astronomically big data does as well.

By all means, let’s keep our eye on how to leverage new patient-centric data sources like wearable health  trackers. It seems clear that such data has a role in stepping up patient care, at least once we understand what part of it is wheat and which part chaff.

That being said, continuing to amass data at exponential rates is unsustainable and ultimately, harmful. Sometimes, setting limits is the only way that you can be sure that what remains is valuable.

Will We Need Billing Codes Once We Have Nice Structured EHR Clinical Data?

Posted on July 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I had a really fascinating discussion recently with @AlexHBurgess where we discussed the role of billing codes in an EHR today and also the future of billing codes as EHR notes get much better and more granular. This is particularly interesting to me as I’m at the HealthPort HIM Summit the next couple days.

Here’s the question that started the conversation:

This was @AlexHBurgess’s response:

And then I replied:

The last question is something worth chewing on. I’ll have to ask it of a few HIM managers the next couple days. I think the simple answer is that we’ll still likely need billing codes. I don’t think that our payers are forward thinking enough or at least progressive enough to try and push forward a non-billing code reimbursement system. It’s pretty interesting to think about though.

The second reason I don’t think it’s likely to happen is that the data in the EHR will likely not be good enough. Although, if the data in the EHR (and not just the billing codes that were selected) were how you got paid, then you’d see a dramatic improvement in the quality of the EHR data. So, maybe it’s not a bad idea after all. I’m pretty sure my medical billing friends would scoff at this idea as they think about the number of times they’ve had to have doctors correct something in the paper chart to make sure the billing was ok.

Long story short, I think that you could theoretically get rid of medical billing codes and just use EHR data for reimbursement. However, in practice I don’t really see this ever becoming a reality. At least not in the short to medium term.