Managed Care - September 2008 - (Page 1)

EDITOR’S MEMO Care Editor M A N A G E D Switchover to ICD-10 Codes Poses a Daunting Challenge By John Marcille ncle Sam’s approach to health care coverage profoundly affects what goes on in managed care. Sometimes the influence is direct. Check out our stories on Medicare Advantage (page 24) and MedPAC (page 37). Sometimes, less so. See our cover story (page 14) and the patient satisfaction article (page 41). As we were assembling this issue, the Department of Health and Human Services announced that it wants the switch from ICD-9 diagnostic codes to ICD-10 by Oct. 1, 2011. Never has three years seemed like so short a time. “I’ve watched the ICD-10 storm cloud approach slowly and learned it will require some extensive retooling in claims processing, actuarial services, and finance,” says Jaan Sidorov, MD, a consultant and former medical director who sits on MANAGED CARE’s editorial board. “From a medical director’s point of view, there are implications for network management, disease and/or care management, and HEDIS.” The fact that the announcement comes as no surprise does not detract from the coming challenge. HHS lays out both the nature of the test and why it couldn’t be avoided. “Developed almost 30 years ago, ICD-9 is now widely viewed as outdated because of its limited ability to accommodate new procedures and diagnoses,” the agency states. “ICD-9 contains only 17,000 codes and is expected to start running out of available codes next year. By contrast, the ICD-10 code sets contain more than 155,000 codes and accommodate a host of new diagnoses and procedures.” Many readers by now have boned up on what to expect — at least as much as they’re able to. This is still a breaking news story and all the implications have yet to be explored. We here at MANAGED CARE will be doing just that in the months and years ahead. Change is coming. MC JOHN MARCILLE Managing Editor FRANK DIAMOND Associate Editor U TONY BERBERABE Consulting Editor MICHAEL DALZELL Senior Contributing Editor MARGARETANN CROSS Contributing Editors LOLA BUTCHER JOHN CARROLL MAUREEN GLABMAN MARTIN SIPKOFF Design Director PHILIP DENLINGER Group Publisher TIMOTHY P. SEARCH, RPH Director of New Product Development TIMOTHY J. STEZZI Eastern Sales Manager SCOTT MACDONALD Senior Account Manager KENNETH D. WATKINS, III Director of Production Services WANETA PEART Circulation Manager CONTACT E-MAIL ADDRESSES: Editors: editors_mail@managedcaremag.com Circulation: managedcare@icnfull.com Advertising: advertising_info@managedcaremag.com Reprints: reprints_request@managedcaremag.com JACQUELYN OTT Clinical judgment must guide each clinician in weighing the benefits of treatment against the risk of toxicity. Dosages, indications, and methods of use for products referred to in this publication may reflect the professional literature or other clinical sources, or may reflect the clinical experience of the authors, and might not be the same as what is on the approved package insert. Please consult the complete prescribing information for any products mentioned in this publication. MediMedia USA Inc. assumes no liability for the information published herein. MANAGED CARE (ISSN 1062-3388) is published monthly by MediMedia USA, Inc. at 780 Township Line Road, Yardley, PA 19067. This is Volume 17, Issue 9. Phone: (267) 685-2788; fax (267) 685-2966. Send letters to the editor to Frank Diamond, MANAGED CARE, 780 Township Line Road, Yardley, PA 19067. Letters may be edited for length and clarity. Copyright 2008 by MediMedia USA, Inc. All rights reserved under the United States, International, and Pan-American copyright conventions. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, mechanical, photocopying, electronic, or otherwise, without the prior written permission of MediMedia USA Inc. The copyright law of the United States governs the making of photocopies or other reproductions of copyrighted material. Subscriptions for individuals or institutions in the U.S.A. are $100 per year, $10 per single copy; elsewhere, $120 per year, $22 per single copy. Inquiries about paid subscriptions: Lisa Gardineer, telephone (267) 685-2789; e-mail: lgardineer@medimedia.com. Postmaster: Send address changes to MANAGED CARE, PO Box 2019, Langhorne, PA 19047. Periodicals postage paid at Morrisville, PA, and at additional mailing offices. Major articles are reviewed by appropriate members of the editorial advisory board and/or other qualified experts. Opinions are those of the authors and not necessarily those of the institutions that employ the authors, nor of the publisher, editor, or editorial advisory board of MANAGED CARE. SEPTEMBER 2008 / MANAGED CARE 1

Table of Contents Feed for the Digital Edition of Managed Care - September 2008

Managed Care - September 2008 Editor’s Memo Contents Legislation & Regulation News and Commentary Medication Management Compensation Monitor Archimedes Lends Hippocrates a Hand Some Other Predictive Modeling Programs Messing With Medicare Advantage The Trouble With MAC MedPAC’s Suggestions Sound Familiar The Leader in Patient Satisfaction Formulary Files Plan Watch Tomorrow’s Medicine Ad Index Outlook

Managed Care - September 2008

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