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The benefits seem pretty obvious to me. I work for a hospital and a few years ago we discovered that we had a serious problem with sepsis. Every hospital stru
by noelsusman 8y ago
The benefits seem pretty obvious to me. I work for a hospital and a few years ago we discovered that we had a serious problem with sepsis. Every hospital struggles with sepsis, but our sepsis mortality rates were higher than our peers. As a result, we invested significant resources into improving how we handle sepsis, and our mortality rates have gone down.
None of that would have happened if ICD codes didn't exist.
Frankly, ICD codes aren't even there to improve outcomes or reduce costs. They exist primarily for billing purposes. Anything else we get out of them is a bonus.
- DoreenMichele 8y agoThey exist primarily for billing purposes. Anything else we get out of them is a bonus. Yes. If you work in insurance and have the right code, you know you can pay it without pending the claim and sending a letter requesting additional information. If you have the medical records but no code, you may have to ask for additional info to determine if it is covered.
- specialist 8y agoI'm still struggling with the notion that an insurer, and not the health care providers, now determine medical necessity.
- DoreenMichele 8y agoYou can get a doctor to write a letter of medical necessity. Sometimes that will get it covered. But, yeah, the US healthcare system has issues.
- nradov 8y agoMedical necessity isn't a binary condition. Two providers presented with the same patient chart will frequently come to different conclusions. Insurers (both private and government) do employ doctors to perform medical necessity reviews.
- specialist 8y agoVery interesting. Thanks. Is that because sepsis diagnosis weren't being captured in the transcribed notes? Is this kinda related to the checklist manifestos, a la Atul Gawanda?
- noelsusman 8y agoThe part that required ICD codes was when we compared our mortality rates to peer hospitals. You could theoretically do this without codes, but a standardized way to classify patients makes it orders of magnitude easier. There are companies that ingest data from hospitals and then give it back with comparisons to other hospitals. That's how we were able to identify the problem. Hospitals aren't flush with a lot of spare cash, so if doing this required a bunch of complicated text processing then it probably wouldn't have happened, and trying to compare our notes to notes from other institutions just multiplies the nightmare. With ICD codes we all speak the same language.