A Tough, Needed Transition

As Proto highlighted (“An Imperfect 10,” Summer 2014), our current tools for coding medical conditions and procedures are often obsolete, don’t even include many modern therapies, and are not suitable for new health care delivery models. Adopting the International Classification of Diseases, tenth edition (ICD-10), though burdensome and costly, will ultimately allow physicians and hospitals to convey a more robust and precise account of care. Since billing data will actually reflect the complexity of the care delivered, clinical documentation and coding will be more synchronized. These alignments should enhance quality of care, improve communication among providers, serve as a platform for health outcomes research, and enable providers to make a better case for reimbursement. Many breathed a sigh of relief this past April when ICD-10 implementation was delayed to the fall of 2015. However, on September 4, 2014, the Centers for Medicare and Medicaid Services (CMS) ruled (Transmittal 540) that if an admission or diagnostic test is deemed not “reasonable or necessary,” then CMS will also deny the physician service associated with that activity. With this ruling, don’t be surprised if physicians now demand earlier implementation of ICD-10 so that their work can be more precisely and accurately coded and their work justly compensated.

Robert A. Philips, Executive Vice President and Chief Medical Officer, Houston Methodist


Regaining Balance

The recent publication of the main results of the Kronos Early Estrogen Prevention Study (KEEPS) continues the trend toward re-establishing a balanced approach to menopausal hormone therapy (MHT), as Proto discussed in “New Fuel for the Hormone Therapy Debate” (Spring 2014). In a group of 727 healthy women starting cyclic MHT early in menopause, there was no excess of vascular complications or evidence of worsening markers of atherosclerosis over the four-year study. There was clear improvement of menopausal symptoms, blood lipids and decreased bone mineral loss.

So, what have we learned? Mainly, that there was an overreaction to the initial dire conclusions of the Women’s Health Initiative and that MHT given to the correct women at the correct time is safe and appropriate. Doctors and patients must take this lesson to heart; when a single study bucks the tide of dozens of other studies, this is the time to increase the scrutiny of that study, not to toss the metaphorical baby out with the bathwater.

Frederick Naftolin, Professor of Obstetrics and Gynecology, New York University