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February 12, 2010

Quality Improvement and Public Reporting

There are a number of developments that hospitals should be aware of as they pertain to public reporting and quality improvement opportunities.

Diagnostic and Procedural Coding
Proposed DSM-5 Changes. Earlier this week, the American Psychological Association released the proposed changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 will be required for reporting on claims starting in May 2013. For a detailed timeline of the DSM-5 process and to review the proposed codes and changes, please go to www.dsm5.org.

The proposed changes have attracted attention from a variety of health care practitioners and consumers as some conditions and symptoms are re-classified, such as Asperger’s disorder proposed inclusion in autism; binge eating as a disorder; suicide risk assessment; medicalization of grief; medicalization of behavioral addictions which for now include gambling addiction; etc. As these codes will have a significant ramification for clinical diagnosis, treatment, payment, and classifying patients, providers are encouraged to submit comments by April 20, 2010. To submit comments, please go to http://www.dsm5.org/about/pages/overallcommentspage.aspx.

ICD-10 CM Codes. While I know many hospitals are actively engaged in planning and development for the transition to ICD-10 CM codes, hospitals are encouraged to continue with their initiatives as the transition to ICD-10 CM occurs on October 1, 2013.

The ICD-10 codes were developed by the World Health Organization (WHO) with work started in 1983 and completed in 1992. The majority of developed countries and developing countries have transitioned to the ICD-10. Under an agreement with WHO, the United States does some clinical modifications to the disease section, thereby the United States edition is known as ICD-10 CM. Additionally for the United States transition, rather than utilize the ICD-10 procedure codes, the United States has an edition known as the ICD-10-PCS (ICD-10 Procedural Coding System).

The transition from ICD-9-CM to ICD-10-CM will be significant and does require many internal and system changes as well as internal hospital discussions on how best to address historical, current, and future records for patient care analysis and disease trending.

In addition to the internal system and information changes that will occur and are significant, hospitals will need to ensure their staff are trained and ready to utilize these codes as the transition from about 25,000 ICD-9-CM codes to approximately 150,000 ICD-10-CM codes is significant. However in pilot tests that IHA hospitals were involved in with the American Hospital Association, the time spent on each case was reduced as the medical informatics and coding staff became familiar with the code sets. Many also found it helpful as the ICD-10 versions offer more coding choices for diseases, conditions, injuries, etc.

For additional information, please go to the CDC’s National Center for Health Statistics (NCHS) web site as NCHS is responsible for the development, maintenance, and ongoing review of ICD-10-CM and ICD-10-PCS.

IHA Illinois Hospitals Caring For You web site
The IHA Illinois Hospitals Caring For You web site will be previewed by hospital contacts starting the week of February 15. Hospital contacts will be notified of the general training on the web site and then sent an individual account identification number to access their hospital information as it will appear on the web site. During the review time, hospitals will be asked to submit any questions or changes to IHA by Friday, March 5. Pending the volume of comments or changes, IHA will then notify hospitals of the "Go Live" date.

Hospital Compare Preview – Outpatient Imaging Efficiency (OIE) Measurements
During February and March, 2010, the Centers for Medicare and Medicaid Services (CMS) will be conducting some ‘dry runs' of the outpatient imaging efficiency measurements that will be included in Hospital Compare as part of the Outpatient Data Quality Reporting Program. The ‘dry run’ information will be at a hospital specific level and will be for calendar year 2007 for hospital fee for services paid claims data (no Medicare Advantage claims).

The OIE measurements to be included are:

Quarterly Quality Series for Rural Hospitals The 2010 Quarterly Quality series for rural hospitals kicks off on Tuesday, April 6 and once again will be televideo conference at several convenient sites throughout Illinois.

If you have additional questions on any of these items, please contact Pat Merryweather.