CLINICAL NEWS
The ACA is Here to Stay
ICD-10 By the Numbers
After multiple delays, ICD-10 is finally set to go into effect on October 1, 2015 – the first full replacement of diagnostic and procedure
codes in 30 years. The new ICD-10 codes are longer, complex, more
specific, and require greater knowledge of anatomy, physiology, and
Greek and Latin bases for medical terminology.
• ICD-10-CM has 69,823 diagnosis codes, nearly five times that of
ICD-9’s 13,000 codes.
• ICD-10 introduces 125,000+ new diagnostic and procedural codes.
The Supreme Court ruled to uphold health law subsidies in the King v. Burwell
case. Now that we’re on the other side, let’s take a look at what could have been,
based on projections from CMS and research institutes:
• 34 states without their own exchanges would have lost premium subsidies
had the federal government exchange been dismantled
• 6.4 million Americans could have lost their premium subsidies
• 300,000 employees could have lost their employer-subsidized health insurance
• 8.2 million Americans would have likely become uninsured (including people
opting out of insurance if premiums spiked)
• 55% projected rise in premiums would have occurred (to account for the
loss in financial assistance through the federal marketplace)
Source: Time, Centers for Medicare and Medicaid Services, Kaiser Family Foundation
For our more adventurous hematology patients, these new codes
may come in handy:
W56.49
OTHER CONTACT WITH SHARK
W56.22XA
Welcome to the 21st Century
The passage of the 21st Century Cures Act raises funding
for medical research at the
National Institutes of Health
(NIH) and allocates funds to
help the U.S. Food and Drug
Administration speed up the
drug approval process. Over
the next five years, the bill
mandates:
8.75 BILLION
$550 MILLION
$1.75 BILLION
$
STRUCK BY ORCA, INITIAL
ENCOUNTER
in additional funding to the NIH for medical research
V96.00XS
to the FDA to accelerate the drug approval process
UNSPECIFIED BALLOON ACCIDENT
INJURING OCCUPANT, SEQUELA.
Luckily, though, CMS recently announced a 1-year grace period for
claims bearing the ICD-10 diagnostic codes.
to the NIH each year for the creation of the “Innovation Fund”
(mandatory funds that are not part of the spending bills that need Congress’ approval)
To offset this spending, though, cuts had to be made elsewhere, namely through changes
to Medicare and Medicaid entitlement rules to trim $500 million over the next decade and
$7 billion the following decade from budget deficits.
Source: Becker’s Hospital Review
Source: The Wall Street Journal, NPR
Gene Trial Mis-Match
Precision medicine and genomic profiling promise to deliver new targeted molecular therapies for cancer treatment; however, before those therapies are ready
for clinical use, they need to be tested in patients with those specific mutations.
Unfortunately, only a small portion of patients with potentially actionable genes
actually go on to enroll in genotype-matched clinical trials, according to a recent
analysis.
• In total, 2,000 patients with advanced cancer underwent broad-based
genomic testing.
• 35 genes were identified as “actionable” (given the potential to be targeted
with approved or investigational therapies).
• 789 patients (39%) had at least one mutation in one of these genes.
• Only 83 (11%) of these patients later enrolled in a genotype-matched trial
targeting these alteration ̸()M!