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Industry Insight

Transition to ICD-10 May Mean Financial, Data Loss
for Pediatricians

Pediatricians may lose money or data during the mandated conversion from ICD-9 to ICD-10, according a study by University of Illinois at Chicago (UIC) researchers published in Pediatrics.

The Centers for Medicare & Medicaid Services provides a conversion key called a general equivalent mapping code translation system, but it’s complex and often difficult to interpret. While some codes map easily to the new code, others have convoluted mappings that can be inconsistent.

Researchers have reviewed commonly used codes to predict how the transition from ICD-9-CM to ICD-10-CM likely will affect pediatricians’ practices. Some studies estimate that ICD-10 implementation will cost between $83,000 and $2 million per practice, depending on size.

The researchers wanted to find out which codes could potentially cause financial or information loss if they were mapped to incorrect ICD-10 codes. They used 2010 Illinois Medicaid data to identify ICD-9-CM codes for pediatric patients treated at the University of Illinois Hospital & Health Sciences System. They identified 2,708 diagnosis codes used by pediatricians in 174,500 patient encounters for a total Medicaid payment of $12,298,520.

Using a Web-based tool developed at UIC, the researchers inputted the ICD-9 codes and mapped them to ICD-10 codes. The codes then were categorized by the complexity of the transition—from easy to complex or convoluted—and assessed for financial impact.

Twenty-six percent of pediatric ICD-9 codes have complex mapping to ICD-10, representing 21% of Illinois Medicaid pediatric patient encounters and 16% of total reimbursements.

If pediatricians use incorrect mappings or if insurers disagree with how examinations and procedures are coded, practices may not get reimbursed and clinical information can be lost, says Andrew Boyd, MD, an assistant professor of biomedical and health information sciences at UIC and a study coauthors.

“Many pediatric practices—perhaps more than other medical fields—practice on a narrow financial margin and are often reimbursed at lower rates than other specialties, particularly by Medicaid,” says Rachel Caskey, MD, an assistant professor of pediatrics at UIC and a study coauthor. “Any discrepancies that could cause even a small decrease in reimbursement—even 5%—could have a substantial impact on some pediatric practices, particularly an outpatient practice with a large Medicaid population.”

— Source: University of Illinois at Chicago


EHRA Elections Move Experienced Leadership Into Top Roles

The Electronic Health Record Association (EHRA), a trade association of companies that provide the majority of operational EHRs to hospitals and physicians across the United States, announced new leadership for the coming year after the annual elections. Two executive committee members were reelected to two-year terms; two new members were added; and a new chair and vice chair were elected.

Mark Segal, PhD, vice president of government and industry affairs for GE Healthcare IT, vice chair emeritus of the EHRA, and current chair of the Public Policy Leadership Workgroup, was elected to a one-year term as chair of the EHRA.

Joining Segal in the role of vice chair is Sarah Corley, MD, chief medical officer at NextGen Healthcare. Corley has served on the EHRA’s executive committee and as chair of the EHRA’s Patient Safety Workgroup. She brings her experiences as a former commissioner on the Certification Commission for Health IT and as a practicing physician to the EHRA’s work.

Reelected to the executive committee for two-year terms are Meg Marshall, director of government health policy at Cerner Corporation and vice chair of the Public Policy Leadership Workgroup, and Ginny Meadows, RN, vice president of regulatory strategy for McKesson Corporation and chair of the Quality Measurement Workgroup.

Joseph Geretz, chief software architect at SRSsoft and vice chair of the Certification Workgroup, and Sasha TerMaat, program director at Epic and leader of the Meaningful Use Workgroup, were elected to two-year terms.

Hatem (Tim) Abou-Sayed, MD, medical director of EMA plastic surgery at Modernizing Medicine will complete the second year of his two-year term during the coming year.

Michele (Mickey) McGlynn, senior director of strategy and operations for Siemens Healthcare’ Health Services, who served two terms as EHRA chair, will move into an ex officio role.

Leigh Burchell, vice president of policy and government affairs for Allscripts, having served two terms as vice chair, will complete her fourth year on the executive committee.

— Source: Electronic Health Record Association


eHealth Technologies Elects Scott as Board Chairman

eHealth Technologies, a provider of continuity-of-care solutions, announced that Ray Scott has been appointed to the board of directors and elected as chairman.

Scott brings offers many years of experience in HIT and is a respected authority in health information exchange (HIE) and health care informatics. He cofounded Axolotl Corp in 1995 to provide collaborative electronic workflow solutions for communities of health care providers. He was instrumental in creating the concepts around clinical messaging, turning EMR communication into a reality and establishing it as a necessary requirement for successful HIEs and regional health information organizations.

Since selling Axolotl Corp to OptumInsight, Scott has been advising several HIT and informatics companies and been active in the eHealth Initiative and other industry organizations.

— Source: eHealth Technologies