With the U.S. Department of Health & Human Services latest denouncement of healthcare providers who fraudulently upcode, pressure to ensure that the coding process itself is accurate continues to mount. According to Lynne Thomas Gordon (pictured), CEO of the American Health Information Management Association, moving from ICD-9 to ICD-10 should help alleviate some of that pressure.
"The transition to ICD-10-CM and ICD-10-PCS now will provide a mechanism for tightening the link between classifications and their applications in electronic health records," Gordon told FierceHealthIT in an exclusive interview. She added that the process has "broad implications for improving patient quality, safety, public health surveillance and the adoption of clinical best practices."
Ahead of next week's AHIMA conference in Chicago, Thomas talked about her expectations for the coming year, given ICD-10's delay, as well as what she thinks about the calls to skip ICD-10 and go straight into ICD-11.
FierceHealthIT: What will be the single-biggest challenge impacting healthcare information management professionals in the coming year and how can health IT leaders prepare?
Gordon: Whether it is clinical documentation improvement, decision support, data analytics, health information management, coding or revenue cycle, all of us need to adjust to a constantly changing environment. By being agile as we move from paper to the electronic health record, health information professionals can continue to provide valuable leadership in data integrity and governance.
We need to continue to do more with less to provide the reliable and trusted data that leads to optimum decisions. Change is a part of life so we might as well embrace it and commit to lifelong learning to stay abreast of the latest information.
FHIT: Do you anticipate the same response to the new ICD-10 deadline that we've seen in the past? For example, will providers put ICD-10 transition plans on the back burner to focus on Meaningful Use and other IT initiatives?
Gordon: We all know that it is human nature to procrastinate. But now that a firm implementation deadline has been set, the entire healthcare community has the certainty it needs to continue to move forward with implementation, testing and training. By moving to ICD-10, we will have better quality of care through better health information.
FHIT: What is the importance of adopting new codes sets in order--going from ICD-9 to ICD-10 to ICD-11--as opposed to jumping ahead to ICD-11?
Gordon: It is critical for coding initiatives to move in order. It would likely be another decade before ICD-11 could be implemented in the U.S, and we simply can't wait another 10 years to replace the obsolete ICD-9 code set. Not at a time when high-quality data is more important than ever to support signature healthcare initiatives such as meaningful use, value-based purchasing, payment reform, quality reporting and accountable care organizations.
FHIT: HHS and the Department of Justice have promised to crack down on providers who use EHRs to enable fraud, such as upcoding. What are your thoughts on the situation?
Gordon: AHIMA continues to advocate for national coding guidelines for hospital reporting of emergency department and clinic visits in place of the current system of internal guidelines developed by each hospital for its own use, as that is another step that should be taken to improve the quality and consistency of coded data.
It is important to remember that use of coded data has moved well beyond actual payment of the bill, which increases the need for coding accuracy. CMS, other payers, states and accrediting agencies all use claims data either directly or indirectly to support quality measurement and public reporting. Health information management professionals play a critical role in not only coding, but the entire healthcare system. The information collected must accurately and fairly represent hospital performance and outcomes of care.
FHIT: Last year, one of the big themes of the AHIMA convention was trying to break down silos between providers, payers and vendors with regard to ICD-10. How important will it be to continue such efforts?
Gordon: Providers, payers and vendors are all interdependent and their ability to work together will help everyone reach the Oct. 1, 2014 deadline for ICD-10 compliance. This is a prime opportunity to open up the lines of communications so that issues can be identified and worked through to ensure a successful transition for all.
Editor's note: This interview has been edited for length and clarity.