When turkeys attack

By Steve Brawner
© 2015 by Steve Brawner Communications, Inc.

Have you ever thought about what you would do if you were attacked by a turkey? If it happens after Oct. 1, someone will have thought about it for you.

That’s the date the nation’s medical providers – including 38,000 of them in Arkansas – are required by the government to switch from the ICD-9 coding system to ICD-10. The codes are what your doctors transmit to insurance companies and government agencies to get paid.

ICD isn’t just a national standard but a worldwide one. The United States began using ICD-9 in 1979. ICD-10 has been around 25 years, and much of the world has already switched to it.

ICD-10 is “better” in that it’s much more specific. ICD-9 uses 13,000 codes; ICD-10 uses 68,000 – exactly which bone was broken and on which arm, for example. Knowing this information helps payers – insurance companies and the government – detect waste and fraud. It also helps researchers better understand problems and trends.

But ICD-10 takes that specificity to an extreme. According to the fact-checking website Politifact, it has nine separate codes for turkey-related injuries, including one if the patient was struck by a turkey and another if the patient was pecked.

Requiring the nation’s medical coders to switch to that kind of system is not cheap. An American Medical Association study found that, between training costs and software purchases, a small practice will spend between $56,639 and $226,105, with larger practices spending up to $8 million.

That’s a big expense and a lot of trouble, and as a result, the state’s medical providers aren’t prepared for ICD-10. Of the 95 clinics that have responded to an Arkansas Medical Society survey, only 16 percent are ready now, and 30 percent do not expect to be ready by Oct. 1.

The procrastinators are probably hoping the switch will be delayed, as has happened twice. The switch originally was supposed to occur in 2008. But Tami Harlan, deputy director of the state’s Medicaid program, said it’s unlikely the feds will allow another delay. She said her agency is working “feverishly” on the change. On Oct. 1, if a doctor’s office sends Medicaid an ICD-9 code, it will be rejected immediately. The clinic still can be paid by paper check, but that will be costly for it and for the Medicaid program, and the payment will be delayed. So on Oct. 1, expect unprepared clinics across the state to start scrambling.

Is ICD-10 worth it? I don’t know, but we shouldn’t be surprised by all this. This is the system we’ve set up.

American medicine is based on the expectation that most care will feel almost free to the patient as the care is provided. We pay into a big system upfront through insurance and taxes, pizza buffet style, and then expect to pay little afterwards. If we want a $25,000 car, we’ll get a loan because, hey, it’s got a sun roof and we earned it. For a procedure that restores our health or saves our life, we’re outraged if asked to pay almost anything because it’s not fair, and besides, that’s why we have insurance. The system should pay for that.

But if we expect government and insurance bureaucracies to pay the big bills, we should expect them to behave as bureaucracies behave. They want to know how the money is spent. They want to put things into boxes. They want to control, and at some level, they have a fiduciary duty to do so.

I’ve heard more than one well-informed person – specifically, Sen. David Sanders, R-Little Rock, and Cheryl Smith Gardner, executive director of the Arkansas Health Insurance Marketplace – say the health care system inevitably will move in one of two directions: more consumer choice, or more government command and control. They and I would prefer more consumer choice.

That’s difficult in health care. Consumer choice requires consumer responsibility, and it’s not like we can go shopping for the best deal when we’re in the ambulance after an auto accident. But at the very least, for smaller stuff like if turkeys attack, we probably ought to pay for it ourselves, if we can. We probably shouldn’t have been messing with the turkeys in the first place. For the bigger stuff, right or wrong and unless expectations change, we’re probably stuck with something like ICD-9 or ICD-10.

Or ICD-11, which should be ready for whoever wants it by 2017.

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