icd10 implementation: lessons from sa’s experience rajesh patel september 2014 windhoek, namibia
TRANSCRIPT
ICD10 Implementation:Lessons from SA’s experienceRajesh PatelSeptember 2014Windhoek, Namibia
Objectives
• What is health governance?• Need for language standardisation• SA background to implementation• NAMAF or ?: Coding in Namibia• Implementation needs• International developments• Q&A
Stakeholders
Government/funders• Health governance
Service providers• Health governance• Medical audit
Coding relevant for all stakeholders!
Health governance
1. Health needs2. Health services or benefits3. Actions, interventions, programs4. M&E
• Medical Scheme:• Vehicle for the collection of funds to provide for the health
needs of “private” members
Dx Prevalence SA (%): Use of coding
Disease 2010 2011
Asthma 2.8 3.1
Diabetes 2.8 3.1
Hypertension 9.9 10.6
HIV (CMS) 1
Need for language standardization!
• ICD or ICPC• ICD10 or ICD11 or other
• Which one? • Choose and make the move!
Why Is Diagnostic Coding Important?
• used in the health care industry to classify and organize groups of diseases, disorders and symptoms.
• intended to improve both the response time and the accuracy of medical organizations.
• it improves the services that are available to the average person, and also makes them more manageable from an organizational perspective.
• is an information conduit, facilitating communication between different agencies and health care professionals.
Background
• Managed care introduction in SA 1995• Need for clinical information to be captured• Establishment of PHISC from RAMS/BHF
offices• ICD10• ICPC• ICD9CM
• 1997: DG announced adoption of ICD10• No documented record
Background
• MSA & Regulations 1999• PMB• Minimum data on claims, incl. diagnostic code
• PMBs from 2000• NHA of 2003 chapter 9• Need for coding to access PMB benefit
• ICD10 implementation for private sector billing from June 2005. Implementation TT co-ordinated by CMS
• 2011: Role of coding in NHI• 2012 Ministerial implementation task team
Implementation in Namibia
• Do you have regulatory support/enabling legislation?• Yes!• No!
• Voluntary implementation• Start with funder coding for managed care activities• Lots of documentation from SA
» www.health.gov.za
NAMAF or ? co-ordination
• Emphasis on coding training• Accredited coders• Coding trainers• Train the trainer programs• Staff coding training• Provider coding training
NAMAF or ? co-ordination
• Technical team: ICD10 Implementation Task Team• Coding expertise• Business process
expertise• IT system expertise• Clinicians with HIS
expertise• Governm. officials
NAMAF or ? co-ordination
• Standardisation of rules, use and systems to capture and communicate data
• Quality of coding• Confidentiality concerns
• Legitimate• Purpose of coding• Excuse for not co-operating
• Call centre
Grouper
• ACG: Johns Hopkins• DRG: various
International developments
• WHO: Family of coding classification• Diagnostic• Procedure• Disability
• MRC in SA: collaborating center• ICD10 rollout in US current• Development of ICD11
Thank You