Value-based care is more than the new ICD-10

October 9th, 2015 / By Kristine Daynes

I’ve heard value-based care called “the new ICD-10.” I understand the comparison, at least in reference to regulatory disruption. But aside from the CMS willpower behind value-based care, I don’t see a lot of similarities.

I think of ICD-10 as a new language that requires translation within every system using ICD codes. All system users need some level of literacy training. Value-based care is this and more. It is like moving to another state—even another country—where the customs, geography and idioms of speech are entirely different.

Value-based care requires a new way of doing business: adapted systems, new skills, and new clinical and financial processes as well as new payment models and standards. Whereas the ICD-10 code set is standardized and had been adopted in other countries, with value-based care, we don’t yet know what the standard will be or which models will endure.

The comparison of value-based care to ICD-10 doesn’t hold up in many ways. But ICD-10 itself may prove to be a solid support in the transition to value-based care.

ICD-10 is a more precise code set, better than ICD-9 at representing modern practice and measuring health care. For example, the Coalition for ICD-10 describes a scenario where Patient A is admitted to the hospital for planned surgery to reposition an implanted deep brain stimulator. The care team performs a craniotomy, repositions the lead, and discharges the patient after an overnight stay. Patient B is received as an emergency admission due to leakage from a previously implanted ventricular shunt. The care team performs a craniotomy to stop the leakage and keeps the patient for an extended hospital stay. In ICD-9, both scenarios would be coded with the identical codes:

  • 2 Mechanical complication of nervous system device, implant, and graft
  • 23 Reopening and graft

Under ICD-10 the patients are coded very differently. Patient A would be:

  • 120A Displacement of implanted electronic neurostimulator (electrode) of brain, initial encounter
  • 00W00MZ Revision of neurostimulator lead in brain, open approach

Patient B would be:

  • 03XA Leakage of ventricular intracranial (communicating) shunt
  • 00W60JZ Revision of synthetic substitute in cerebral ventricle, open approach

ICD-10 is better at communicating patient information that is essential to measure differences in symptoms, complications, conditions, and treatment. Providers who can appropriately document and code for ICD-10 will be better able to manage value-based contracts in the following ways:

  • Understand variation in resource utilization
  • Explain clinical risks and differences in patient outcomes
  • Track clinical practice, technology, and medical devices that aren’t represented in ICD-9
  • Assess the full continuum of care from the physician office to the hospital to ambulatory services
  • Improve the specificity of documentation and coding for bundled and capitated payment

Without the specificity of ICD-10, how else could we fairly represent the delivery of care for value-based payment?

There is one noteworthy similarity between value-based care and ICD-10. Those organizations that embrace the change have an advantage. With ICD-10, an early start gave organizations time to train and test. With value-based care, the advantage to moving now is being able to choose your preferred business model, even to shape the local market. The alternative is to be left behind while others make the journey.

Kristine Daynes is marketing manager for payer and regulatory markets at 3M Health Information Systems.

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