This afternoon, I’m embarking on my latest of many long-distance automobile journeys. I’m driving first from suburban Milwaukee, Wisconsin to Reading, Pennsylvania (the town that the first railroad on the Monopoly board is named after), where I’ll be picking up one of my oldest friends, music blogger and master librarian Curtis, along with a portion of his vast musical instrument collection. From there, we head to Marietta, Georgia to interface with another old friend, musician and noted watchmaker-to-the-stars Steve, to record what will be my first full-length album of any quality in Steve’s home studio (just off his dining room; Steve’s a confirmed bachelor).
As I get ready to encounter the wonder and horror of the American roadways in equal parts, news directly and indirectly related to our health care system will not pause to await my return. In fact, if the last week is any indication, I’m beginning to realize why Godot never bothered to show up.
Since I’m in a musical state of mind, allow me to begin with the all-too-familiar case of the death of Whitney Houston. Until the complete autopsy and toxicology reports are introduced with great fanfare into the 24-hour news cycle, I am left to put pieces together based on assorted widely released reports. The reports thus far seem to point to a death from prescription drugs, rather than the illegal drugs she had admitted using in her past in interviews conducted during her lifetime.
There is perhaps some good that can come out of one more celebrity death in a long line stemming from misuse of prescription drugs. Responding to an epidemic of prescription drugs obtained illegally and sold on the street, as well as the well-publicized deaths of Houston and others, the State of New York is now looking at instituting real-time reporting of prescription data from pharmacies around the state. Anyone who wants to fill a prescription anywhere in the state at any time would be checked through the proposed database. The person’s demographics and history of drug utilization would be reviewed, with suspect prescriptions denied on site.
Realizing that there are 50 states, it should be noted that even if such a system is put in place, it will be a small beginning. It continues to be a sad commentary that people with the financial wherewithal to poorly self-medicate will continue to do so until some type of national database is put into place.
In other news, HHS Secretary Kathleen Sebelius announced yesterday that the provider compliance date for ICD-10 will be pushed back from its current date of October 1, 2013, it what appears to be a massive cave to the AMA and other shrill elements on the provider side. In her statement, Sebelius made reference to “administrative burdens” and the intent to work with the provider community to “re-examine the pace at which HHS and the nation implement these important improvements to our health care system”.
If all of you can now grab your welding masks, safety goggles or other appropriate eye wear, this is a short warning that I’m going to gloat now, and I want to save all of your corneas from the supernova of my past brilliance.
Begin your journey of enlightenment by clicking here. Next, scroll down to the attached document in the lower right-hand corner. On September 24, 2008, during the comment period of the proposed rule for ICD-10 implementation, I submitted a recommendation to CMS stating (admittedly, in sometimes clumsy language usage) that ICD-10 should be skipped altogether and that the American health care system should instead prepare for the worldwide release of ICD-11 in 2014. As you can see by my comments from 41 months ago, I theorized that if ICD-10 was instead chosen as the standard, the United States would find itself exactly where it finds itself right now, that being the rest of the civilized world using the sleek, up-to-date disease, symptom and morphology coding system, while the United States putts along with the AMC Pacer.
When the Final rule was released in mid-January of 2009, CMS stated that a clinical modification for ICD-11 would not be ready until the year 2020, so my idea was not feasible. I know this is going to be hard to believe, but your government didn’t tell you the entire truth in this case. ICD-11 will include a clinical modification upon release, so the 2020 timeline is talking about an “American” clinical modification that would enable domestic insurance carriers to more easily deny claims.
Admittedly, since my comment, the World Health Organization has moved back the ratification date of ICD-11 to May of 2015. Yet if ICD-10 implementation is going to be delayed to a date extremely close to one year before the global ratification date of ICD-11, can anyone tell me what the point is of forcing ICD-10 on to the American health care delivery system to stay current with the rest of the world for roughly 12 months? The further we push back ICD-10 compliance, the worse of an overall investment it becomes. To put it in a more popular context, if I want a smart phone, I could go out right now and buy a smartphone and be needlessly frustrated about missing features, or I can wait for the latest version to come out a few months from now and be happy and up-to-date. To me, this is all about getting everyone frustrated for no apparent reason, and I feel very comfortable telling everyone within earshot that I warned CMS about this.
For those of you who want a peek into the future, here is the working alpha version of ICD-11. Bluntly, as a coder, I find it to be a superior system to ICD-10, but given that I am turning 46 in two months and we’ll be over 20 years into global ICD-10 implementation by the time the United States decides to put it to use, I am predicting today that I’ll never use ICD-11 as a coding system in my occupational lifetime.
America. Feel the exceptionalism!
Paul Spencer’s Friday blog on industry issues will return on March 2nd. Until then, if you want a chance to meet Paul Spencer, as well as a chance of winning an IPad, consider registering for the Fi-Med RAC Summit on April 16th and 17th, 2012. Visit the Summit website for more details.