Health Care Thoughts: Rand Paul is a Loon, However…..
by Tom aka Rusty Rustbelt
Health Care Thoughts: Rand Paul is a Loon, However…..
Rand Paul told an Iowa crowd about “Obamacare codes” and listed some of the wackier codes.
Problem is, he is referring to the ICD-10 adaptation, which was first set in motion by the Bush 43 administration.
ICD-9 has about 17,000 diagnosis codes, ICD-10 has more than 150,000 codes.
Why are we adopting the ICD-10 system?
1) Europe did it
2) “Big IT” will make a huge fortune from the conversion
3) Data miners will have lots and lots to mine
What does it do for providers and patients? Absolutely nothing except cost and a messy transition.
So Paul could have made a valid point about government mandated waste, but that would not have been a good sound bite.
From the Wikipedia article ICD-10
The International version of ICD should not be confused with national Clinical Modifications of ICD that frequently include much more detail, and sometimes have separate sections for procedures. The US ICD-10 CM, for instance, has some 68,000 codes. The US also has ICD-10 PCS, a procedure code system not used by other countries that contains 76,000 codes.
Referenced to this press release http://www.dhhs.gov/news/press/2008pres/08/20080815a.html
So, what is Obamacare mandating, 150,000 codes, 68,000 codes, or 76,000 codes, or does it really matter? Whichever, it is still a shit load of codes.
i don’t know what this all means in practice, but I would be surprised if human beings could keep track of 150,000 anythings.
so i’m gonna guess that if you had an “index” that asked five questions, and the one you answered yes to, took you to a page that asked five more questions, and the one you answered yes to took you to a page…
you’d only have to answer about 8 questions (counting each five-choice as one question) before you got your code. and i am guessing that most practitioners would start at about the fifth question every time because they already know that nothing they do has anything to do with the first four…
and am guessing further that each practitioner would probably only have something like a hundred codes (procedures) that he or his office staff had to be able to find or remember.
“Developed almost 30 years ago, ICD-9 is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses. ICD-9 contains only 17,000 codes and is expected to start running out of available codes next year. By contrast, the ICD-10 code sets contain more than 155,000 codes and accommodate a host of new diagnoses and procedures. The additional codes will help to enable the implementation of electronic health records because they will provide more detail in the electronic transactions. This granularity will also help to improve efficiencies by helping to identify specific health conditions such as Methicillin-Resistant Staphylococcus aureus (MRSA) and other conditions.” http://www.hhs.gov/news/press/2008pres/08/20080815a.html
Rand Paul, GOteaparty strawman.
The F-35 is has hundreds of thousands of failure modes (like a switch fails to open) and possibly several effects of each failed function…..
Doing a shoddy job of tracking failure issues is why F-35 has spent 35% of its test budget and accomplished the easiest 11% of results.
“what does it do for providers (front liners working on instantaneous issues) and patients?”
Not the questions, understanding trends in health is the object.
Think beyond the instant, we need to track how many of this is out there, and what is being done and what works, and that which doesn’t is as important as classifying the work the med techies do in the instant.
May make SW engineers busy and may cost a lot but the benefits are immense.
Unless you want your Dr to be a wizard and use a wand.
Coberley is right about one thing, each specialty will focus on a narrower set of codes, however…
The IT packages will have to be set up with capabilities to manage all of the codes, and
Common codes have been hugely expanded, without looking at my reference materials I seem to remember “spinal stenosis” now has about 30 codes.
And all of this costs a lot of money.
This matches what I am hearing, although reality may not be as catastrophic as this implies.
I think the tech side of this can be in place on time.
Training, testing and debugging? Not looking so good.
Rusty, Check out this history lesson:
Best to you and yours
Innocent that I am , I don’t understand why building a data base to handle billing for a few hundred thousand products has to be so expensive. I’ve made relational data bases that can handle 17,000 records in a flash on my three year old iMac, and I have no more expertise than you can get out of “FileMaker for Nuls”. Imagine what a real database freak can do.
I imagine that the people at Medicare already have all the new codes on spread sheets that with a few tweaks could be imported directly into existing databases. Why would every Drs. office have to hire a data entry person to type in the new records?
Well, I imagine that if everyone involved makes it sound as hard as possible, they can get paid a lot more for it.
Oooops, I almost forgot. Rand Paul IS a loon.
FR – good question
Each provider unit needs a system (or contracts with a company which has a system) to manage the patient from registration thru the appointment/service through the billing and then through the collections.
This is not a matter of data base updates, this is a matter of loading a major software update (or buying a newer system), changing forms and procedures and then training everyone involved, then internal audit and compliance programs to make certain everything is accurate.
On the insurer/payer side (private or government) software has to be loaded that will process the enhanced data base and the information pouring into it. Again, with training, auditing, etc.
The critical path to get all of this done is very complex with lots of choke points. Huge process, multiplied by hundreds of thousands of providers.
Rand has it boiled down to 3 codes: dead, alive, and possessed by demons.
I prefer more nuance.
The codes are utilized to quantify and qualify disorder and illness for qualification and payment to the provider. Commercial Insurance has done this for decades. As I have stated above, the old system is out of date and a new system is needed. What is not mentioned is the expense under commercial as opposed to government would be no different.
i guess i misunderstood the question. while i don’t the the 150k codes would be a terrible problem, an entirely new computer system will.
i forgot this was the new daze.