For doctors, hospitals and insurance companies, all the complexities of medicine get boiled down into a system of codes.
These codes are used to track and pay for every procedure 鈥� like an for mending a broken forearm, or an 800.09 for treating a concussion. But this coding system is now four decades old, and it doesn鈥檛 meet the needs of the medical system today. It was scheduled to be upgraded this October, but Congress delayed it last week. JaeLynn Williams, for one, is seriously bummed out.
鈥淚t鈥檚 kind of like looking forward to Christmas, and it doesn鈥檛 come,鈥� she says.
Williams and her company, 3M Health Information Systems, are helping about 5,000 hospitals upgrade from the old coding system, called ICD-9, to the new one, ICD-10. It鈥檚 a $100 million project for 3M Health. Williams says because it will give doctors, hospitals, researchers and insurance companies better data 鈥� which will allow them to zero in on the best, most cost-effective treatments.
鈥淲ith ICD-9 there鈥檚 only so much information that鈥檚 captured with each code,鈥� she explains. ICD-9 only offers about for procedures. ICD-10 has about 72,000.
(Photo courtesy of Intelicode)
Without enough codes, cardiologists, for example, can鈥檛 differentiate between the dozens of different kinds of implants now commonly used to open clogged arteries. Williams says, 鈥淪o we can鈥檛 use the data to analyze which implant had a better outcome. We can鈥檛 use the data to determine which implant results in the shortest recovery time. You won鈥檛 be able to use the data to understand which implant had the best long-term success.鈥�
For that, health care needs to upgrade to ICD-10, and everybody needs to make the transition at the same time for it to work. The White House has been trying to coordinate that . But some doctors in smaller practices welcome the delay, like Eric Novack, an orthopedist in Phoenix.
鈥淚t鈥檚 good news for us because there are enough challenges going on now with things changing in health care,鈥� he says.
For Novack, upgrading to the new coding system means all 10 doctors in his practice have to take a couple of weeks off from seeing patients to learn how to use it. And support staff needs expensive training, too.
鈥淲e can put that on hold, and not have to worry about having to spend that big chunk of money at this time,鈥� he says.
Doctors and small hospitals are already struggling with beyond the ICD-10 upgrade, like just implementing electronic health records in the first place, says , a health information technology consultant.
鈥淲e鈥檝e asked way more than we鈥檝e ever asked from an IT standpoint, from a project standpoint, from a dollar standpoint,鈥� Lavelle says. 鈥淭heir vendors haven鈥檛 provided them updated software, so they can鈥檛 start testing or planning, and they just haven鈥檛 gotten started or pushed their vendors to get started.鈥�
But big hospitals and insurance companies have invested heavily in being ready to switch to ICD-10 six months from now.
They鈥檝e already sunk millions into re-training staff, and many have started testing the new systems in anticipation of the October 2014 deadline. After all, the Department of Health and Human Services was as recently as February.
And HHS didn鈥檛 ask Congress for the delay, it was part of a political compromise. Congress pushed back the deadline, which many doctors wanted, at the same time it passed a major Medicare bill that doctors didn鈥檛 like.
3M鈥橲 Williams says her clients worry that the delay will make upgrading harder in the future.
鈥淚 think the biggest issue with the delays is the lack of trust that any new deadline will be held to,鈥� she says.
In a written statement to NPR, HHS says it is studying Congress鈥� action, and 鈥渨ill provide guidance鈥� on a new deadline for the coding upgrade 鈥渟oon.鈥�