ICD-10 looks a bit beleaguered this week. That's after state insurance commissioners issued a proposal under which health insurers would not be permitted to consider ICD-10 within their medical-loss ratio (MLR) – and physician and hospital organizations backed the idea.
That's right: If the NAIC (National Association of Insurance Commissioners) draft proposal sticks as is, health plans will not be able to count the leviathan ICD-10 conversion – which Deloitte Consulting and others have deemed the most expensive project the U.S. healthcare industry has ever undertaken – as part of patient care and quality improvement spend.
Medical-loss ratio is the percentage of health insurance premium revenues that providers allocate toward covered services; healthcare reform will require plans to spend 85 percent on medical claims for large-group policy holders, and 80 percent for small groups and individuals.
[Related: Survival guide for HIPAA 5010: The new medical claims messiah. Podcast: The AAPC's 'ICD-10 Changes Everything' campaign.]
Healthcare industry consortiums are somewhat divided on the matter. The American Medical Association authored a letter to NAIC, praising it for “developing a proposal that limits quality improvement to those activities that promote measurable, direct patient benefit." Turns out that the American Hospital Association and Federation of American Hospitals signed the letter as well, according to an American Medical News story.
That prepared soundbite seems to overlook the fact ICD-10 ultimately will bolster healthcare quality and outcomes by increasing specificity which, in turn, will improve the data we have so it can be analyzed more effectively. And ICD-10 links the U.S. to the multitude of countries already using it to identify and manage health threats and outbreaks.
AHIP (America's Health Insurance Plans) agrees. In a letter to NAIC about MLR, in fact, the groups' CEO Karen Ignagni urged NAIC to rethink the matter.
“The effort to convert to ICD-10 codes will improve the ability of health plans to share clinical data among clinicians for quality improvement and care coordination activities, thereby promoting a better understanding of diagnoses and procedures at institutional settings of care to allow better treatment and quality improvement,” Ignanci commented.
AHIMA in an unrelated article stated that healthcare organizations are lagging on HIPAA 5010 and ICD-10, while CSC (Computer Sciences Corp.) listed “dealing with ICD-10” as one of the top 10 challenges providers face in trying to achieve Meaningful Use – an assertion similar to surveys from HIMSS and ICD10Watch.
In addition to ICD-10, health plans would not be able to count fraud detection and prevention within medical-loss ratios.
But what do you think, should ICD-10 count as a patient care and quality improvement spend?
Editor's Note: Vote in our current reader poll, please! Which ICD-10 cost is of most concern to you? We'll report the results and what they mean on ICD10Watch.
Tom Sullivan blogs regularly at ICD10Watch.com.
