Commissioners discuss remedy for ICD-10

Carbon County Commissioners held a workshop with board members and administration from Memorial Hospital of Carbon County Jan. 21, to discuss ICD-10’s affect on the county’s only hospital.

ICD-10 is a coding program mandated by the federal government for all hospitals across the country. Coding will expand from approximately 17,000 codes to approximately more than 80,000 new codes to know and implement for health services across the nation.

Coding is the way insurance agencies, doctors and hospital administrators file injuries or sicknesses that come through hospital doors. The codes are being updated and expanded, to more accurately define those specific types of ailments for insurance coverage.

The new coding program will cost $4 million for Memorial Hospital of Carbon County, but where the money will come from is still a major subject of debate. Commissioners and hospital board members discussed how ICD-10 would affect the hospital come Oct. 1, only eight months into the future.

Carbon County Commissioner Leo Chapman suggested applying for a bank loan as a possibility, but said it will take much time and consideration to plan through.

“We really do need to have a good game plan as to a structure of a loan, and I don’t know if that’s going to get accomplished in this meeting,” he said.

“If there’s a state program that has got a favorable interest over a bank, maybe we’d consider that. Maybe there’s some federal funding out there that helps us with these kinds of things that we’ll become aware of if we keep looking. I have a lot of concerns about the size of loan and term of loan, and type of collateral or what have you.”

However, Chapman said past cash flow issues the hospital had could be of concern in the loan application process.

“The other issue is if you can’t get it simply because of past cash flow history, and the fact is it hasn’t been good for several years up to when it became a wreck,” he said. “After the wreck it has been increasingly getting better to the point where I had some real comfort with it, beginning in the middle of last year. But that’s still not a long enough term for many cautious bankers to want to bite into it.”

Henry Hewitt, a trustee with the hospital, said the commission’s commitment was essential in getting a loan.

“We have to have your commitment,” he said. “We have no tax authority.”

Commissioner John Espy said he thought it was the hospital board’s responsibility to get started in figuring out how to save the hospital from ICD10.

“It seems to me right now is everybody’s sitting in the room and nobody wants to climb into the drivers’ seat and start looking at this,” he said. “My view as a commissioner is that it’s the hospital board’s responsibility to search out those things and start a checklist, saying, ‘okay, this doesn’t work, this doesn’t work’. That’s where we need to start moving forward and getting yesses, nos, maybes and ideas, and maybe a banker will go ‘no way’ and maybe one will go ‘yes’. Somebody’s going to have to start that ball rolling, and I personally think it’s the deal of the hospital board to start that.”

Espy said he also agreed that the commission needed to give its full support in the matter.

“The commission is going to have to stand behind you in that process, and I personally don’t have a problem with that in following you guys down that road,” he said. “But we can’t be sitting here arguing or flipping a coin over who has to start the process.”

To help complete a bank application, the county commission and the hospital board agreed to start a committee of commissioners and hospital board members to fill out a bank application. The committee, proposed by Glode, would consist of herself, Chapman, Hewitt and Dr. David Cesko.

“I think it would offer more support to the board, and I think we would be more on the same page” Glode said. “I think it would be more fair of us to be involved to help you. That’s my opinion.”

After Glode proposed the committee, John Johnson asked Ned Hill, CEO of the hospital, what Quorum Health Resources officials thought about how to fund ICD10.

“What’s the quorum’s position on financing $4 million?” Johnson asked.

Ned Hill said he felt that an issue bigger than ICD10 involved whether or not Carbon County even wants a hospital.

“Do we want a hospital in Carbon County or not?” he said. “Because in the two years I’ve been here we talked about mil support, which didn’t seem to gain much ground; we talked about a tax district, which didn’t seem to gain much ground; and we talked about controlling the self-pay, which didn’t seem to gain much ground. The hospital is not going to get any more efficient without cutting essential service lines. We can’t keep seeing 24 or 25 percent self-pay patients or treating everyone in the county for free, and we are one of maybe two or three hospitals in this state that are not a hospital tax district.”

Glode said she thought putting a hospital tax district on the ballot could be beneficial for the future.

“I think we’d be happy to put a hospital district on the ballot, but we need somebody to run a campaign,” she said.

In a later interview, Chapman said the first meeting for the committee organized to work on the bank application process would likely be Feb. 5 or 6.

“Now we have a direction, and the four of us will sit down and map out our procedure,” he said. “Henry and I were bankers, so we have a good idea on how to propose and present a loan request to a bank.”

What is ICD-10?

According to the American Medical Association and American Health Information Management Association, ICD-10 is a code set for medical diagnosis terminology and replaces ICD-9. The United States is the only industrialized nation not using ICD-10. The ICD-9 code in use does not accurately reflect current technology and medical treatment. ICD-10 is more detailed and specific, and consists of 87,000 codes.

According to Zoll Data Management, ICD-10 is the latest revision of the International Statistical Classification of Diseases and Related Health Problems (ICD codes), which code for medical conditions such as symptoms, complaints, external causes of injury and diseases. This code set is mandated by the federal government for all hospitals across the nation, and designed to allow for more specificity compared to ICD-9 codes. ICD-10 will expand the approximately 17,000 hospital codes under ICD-9 to more than 80,000 codes.

With ICD-10, an ailment such as a broken foot could have a code and 10 to 20 additional codes for more specific accuracy. Those codes will be used to specify elements such as which foot was broken, if the toenail was also busted, if the foot can still be walked on and other details.

According to the Centers for Medicare and Medicaid Services, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by the ICD-10 code sets. ICD-10 consists of two parts, ICD-10-CM for diagnosis coding and ICD-10-PCS for inpatient procedure coding.

The transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms and is inconsistent with current medical practice. The structure of ICD-9 also limits the number of new codes that can be created, and many ICD-9 categories are full.

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by Health Insurance Portability Accountability Act (HIPAA).

 

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