A week in the country

I spent half of Monday talking to the always charming Stacey Harris, a lead analyst for Brandon Hall Group; I spent yesterday at the Masie Center’s New Directions in Learning event in New York and today at SkillSoft’s Perspectives event in Florida.

Quite a bit of running around. All good. Stacey has more ideas in a morning than most people come up with in a year. Elliott is always on form and somehow able to speak in a series of full, coherent paragraphs for hours on end without notes or prompts of any kind. Brilliant.

The most interesting session today was a healthcare workshop presented by a couple of Wellpoint executives about ICD-10, the new medical classification standard, new for this country at least. Very well presented and lots of food for thought. My biggest take-away was that in the next year or two the US healthcare and healthcare related insurance industries will need to train or retrain hundreds of thousands, maybe low millions, of mostly non-medical people in various technical topics including anatomy and physiology for the October 2014 start date for ICD-10.

ICD codes are the seemingly random alpha-numeric headings for diagnoses and procedures on medical forms of different kinds. Under the current coding system, ICD-9, there are about 18,000 codes. In the new system there will be more than 140,000. Under ICD-9 there is one default code for sewing up an artery, “Suture of Artery.” Under ICD-10 there are some 194 codes for suturing an artery, each new code carrying quite a bit more detail than before.

While this may all sound like insider baseball and not of great interest to the rest of us, it’s actually a sea change for the industry with lots of implications for winners and losers going forward. It’s also a large education challenge. How do you, in a timely and cost effective way, train a “coder” who may have no medical or general science background on fairly sophisticated human anatomy and physiology topics? How do you train a couple of generations of doctors, nurses and other healthcare providers to add a great deal more specificity to their patient notes going forward? Can you get competing payer and provider services to cooperate on any of these initiatives at all? Will the mistakes and biases of improperly or lazily coded medical files result in actuarial decisions on reimbursement standards that will remove cover for some types of suffering and overpay for others? Will there be legal minefields created around mismatches between ICD-10 standards and law?

The questions go on and on.

This is a quiet but massive reset of the American healthcare industry, all caused by a global agreement on taxonomy nobody outside of healthcare has thought about or even heard of. The American Medical Association seems to be against it. The related training and change management requirements are challenging (and very large). And before today I knew nothing about this.

We’ll see what the second half of the week brings.