At its September 11 board meeting, the Health Policy Commission (HPC) released preliminary data showing that there has been an increase in high-acuity discharges from Massachusetts hospitals between 2010 and 2017, driven by changing coding practices due to the use of electronic health record systems. According to the HPC, rising acuity contributes to increases in healthcare costs and disparities between hospitals that can invest in more complex EHR systems and those that cannot, and takes clinician time away from direct patient care.
Unfortunately, the HPC reporting does not address the critical factors that may affect the changes in acuity over this time period, nor does it stress the purpose and significance of accurate medical coding. As a result, the conclusions are open to misinterpretation.
Documentation is an important aspect of medical care. The increasing complexity of medicine has been met with an increase in complexity of medical documentation; in fact, ICD-10 coding set was developed to reflect these intricacies. ICD-10, which went into effect in 2015, created very granular codes, meaning the level of specificity was greatly improved. These new codes reflect more specific etiologies, comorbidities and complications and improve the ability to demonstrate severity of illness. In addition to clinical documentation, accurate coding provides data to support quality measurement, as well as the acuity and accurate representation of patients’ medical conditions for better population health management. As electronic health systems become more ubiquitous, they have helped to provide accurate, up-to-date and complete information about patients, resulting in legible, complete documentation for streamlined coding and billing.
“The Health Policy Commission's coding analysis is very preliminary and we look forward to working with them to provide more context and perspective as they move forward towards findings and recommendations,” MHA said in a media statement. “The expansion of electronic health records and adoption of ICD-10 has enabled healthcare providers to more accurately capture patient acuity and previously under-reported conditions. When coupled with policy-driven efforts to move lower-acuity patients to outpatient settings, and the effect of the aging population, it is likely this preliminary reporting simply reflects the results of improved reporting and data. However, where appropriate, we will always work collaboratively with the HPC on improvements to better serve patients.”