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The ICD-10 Drama


By Alec McLure, MPH, RHIA, CCS-P
Director, Product Management

On March 31 Congress passed H.R. 4302 also known as the Protecting Access to Medicare Act of 2014.  A small paragraph in the bill ensured that the switch over from ICD-9-CM of ICD-10-CM (International Classification of Diseases – version 10 –Clinical Modification) in the United States would be delayed by at least a year (October 2015 at the earliest). 

Many in the industry reacted with shock since the previous delay (from 2013 to 2014) had come about after long discussion and politicking. In 2012 the American Medical Association (AMA) had come out swinging after publishing an opinion paper against implementation which was based on cost, complexity of implementation, and the challenges that practices are facing in meeting all other requirements such as Meaningful Use, PQRS, etc. Back then they asked for a two-years’ delay (to 2015) but were only given one (to 2014).

Until just before this bill passed, the industry seemed confident that the October 2014 deadline would stick. Then the modification was made to H.R. 4032, and H.R. 4032 was passed - a less than 4 day’s process – breathtaking speed for this kind of change. The main thrust of H.R. 4032 is the adjustment of the Sustainable Growth Rate (SGR) for Medicare payments, which decides how much physicians get paid for services. This is not popular with the AMA, and it is possible that the additional delay in ICD-10 implementation was inserted to help get the bill passed.

ICD-10 has been around since the World Health Organization (WHO) approved it in 1990 and started to be used by member states in 1994. ICD-10 is used to classify diagnoses in most industrialized nations and has been used to classify deaths/mortality in the US since 1999.

ICD-10-CM (the CM – “clinical modification” is what is used in the US to indicate a version adapted to US needs) was first introduced to the US in 2007 and has been through multiple versions since.  An enormous amount of effort and cost has been expended in adapting systems for its implementation – leaving those who were on or ahead of the curve having to put all these efforts on the back burner.

Although the Centers for Medicare and Medicare Services (CMS) has published a proposed rule stating that the transition will occur on October 1, 2015, another delay is highly possible given the forces ranged against it. The two previous setbacks were not expected, yet they happened.

The WHO is already working on ICD-11 hence it is reasonable to assume that we may end up waiting for that and jumping right from ICD-9 to ICD-11.

National Nutrition Month



While March is designated as National Nutrition Month, the fact is that healthy nutrition habits take time and practice. Nutrition enthusiasts and dieters should carefully choose their resources and also understand that it too is a money making industry. Indeed, food source in the U.S. has become somewhat of a status symbol, a way for people to take pride in themselves and address ethical concerns, however the main issue is nutrition itself.

Whether it’s the paleo diet, juice cleanse, gluten-free diet, vegan, or a combination, the key is moderation and anything in excess could be potentially detrimental to your health.

I sat down with Dr. Lynn Jacobs, an applied physiology professor at Southern Methodist University, to discuss current topics in nutrition.

Dr. Jacobs relies on the Tufts University Health & Nutrition Letter as an up to date source of trusted information. As a publication of Tufts Media at Tufts University, the content of this newsletter is a noteworthy, primary source for nutritional information with evidence based research culminating in peer reviewed journals from the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy. Tufts University Health & Nutrition Letter reports on clinical trials, observational, and epidemiological studies. 

Here are some of the nutrition issues we focused on in our discussion:

New Research concerning Supplements

After years of studies, considerable research has confirmed that supplements (multi-vitamins, Vitamin, C, B, D, etc.) do not increase an individual’s health as compared to eating the actual food sources of these nutrients. Frankly, they’re also not worth the money.

Supplements do not absorb into your digestive system as well as food. Your primary sources such as those in fruits and vegetables are much more effective and cost a lot less. The only time to use supplements is when you have already been diagnosed by a physician or registered dietician with a vitamin or mineral deficiency.

The Gluten-free Debate

While numerous individuals have Celiac Disease, gluten intolerance, there are also thousands of people following a gluten-free diet without ever being tested nor diagnosed with this intolerance. Truth is these people could be missing out on a great nutrient of wheat that has protein and fiber in it, without even checking to make sure they have gluten intolerance. So much literature today states false claims about wheat being a bad nutrient.

Wheat got a bad rep when people realized that so many processed foods have wheat in, but they also had sugar, salt, and fat. However, wheat is not the culprit, the sugar, salt and fat are. It’s crucial to separate fat, sugar, and salt from wheat, for example eliminating refined wheat with saturated fats. A huge concern for individuals following a gluten-free diet is that they may fail to obtain other beneficial sources of whole grains and maintain enough fiber in their daily diet.

Eating Out- Restaurants Posting Calorie Intake

Based on a study Tufts University conducted in Boston of 29 restaurants and 10 frozen dinners, the restaurant selections averaged 18% more calories than claimed and frozen entrees averaged 8% extra calories than mentioned on the label. Potentially this could add up to a 10 pound weight gain in a year. While more efforts are being made to put on labeling in restaurants, fast-food, and frozen meals, accuracy is imperative. More specifically, there needs to more sophisticated scientific analysis of calculating calories of the major macronutrients.

Organic vs. Nonorganic

The organic vs. nonorganic debate is certainly one that continues to boggle my mind as well as Dr. Jacobs’s. Some organic eaters believe that they are receiving more nutrients from organic produce, however this is false. The same to be said for canned fruits and vegetables as they are great alternatives for a lack of fresh produce. Canned fruits and vegetables can be very effective and nutritionally dense since they are usually picked in prime season and shipped quickly, check expiration dates. While organic does not use pesticides, today, bio-pesticides are used more frequently as more natural substitutes to chemicals. Dr. Jacobs made a point to say, “if there’s no scientific, peer-reviewed studies with clinical trials proving that pesticides used in conventionally grown fruits and vegetables cause adverse health effects, then I’m not buying into organic.


Source Information:

The Gluten-free Debate
Source: Tufts University Health & Nutrition Letter. 31.8 (October 2013).

Eating Out- Restaurants Posting Calorie Intake
Source: Tufts University Health & Nutrition Letter. 31.5 (July 2013).

Visit the online version of this newsletter at

How Patients Use Online Reviews IndustryView Report


In October and November 2013, Software Advice surveyed a total of 4,515 patients in the U.S. to reveal trends in the use of online physician review websites. The data was analyzed to answer the following questions:

• Who is using review sites to research doctors?
• During what point in their research are patients using these sites?
• What sites are patients using most often?
• What information are patients looking for?

                        Click here to read the full version of this report.

Congenital Heart Defect Awareness Week


Survey Finds Pediatricians Experiencing Heavy Burden and Stress



According to the Director of athenaResearch, Iyue Sung, there is an increase in frustration of practice maintainece and decreased job satisfaction among pediatricians. After surveying more than 700 pediatricians in collaboration with Epocrates over the last year, they have compiled a detailed list of the chief complaints and difficulties pediatricians are currently facing:


Declining Morale (Figure 1)

  • Only 15% of pediatricians say they are happier than they were five years ago.

  • 47% are less satisfied over that period of time.

  • A key area of frustration that most pediatricians mentioned was trying to balance the immense meaning and satisfaction they derive from caring for children with the drudgery of the administrative and business aspects of their practices.


Stress from Growing Complexity (Figure 2)

  • A significant number of pediatricians report that administrative and clinical complexity have increased their workload while reimbursement has stagnated, adding economic stress to the mix.

  • The trends are similar for both academic and community practitioners. While a somewhat larger proportion of academic-based providers report a greater case mix complexity, percentages for increased workload and insufficent reimbursement were nearly identical for both groups.

Seeing More Patients with Chronic Disease (Figure 3)
  • Both academic and community practitioners are seeing more patients with asthma, depression, diabetes, and hypertension.

  • 80% report seeing more cases of obesity.

  • Overall, there is a widespread sense that reimbursement levels have not kept pace with the increased complexity of these patients’ needs, as well as the growing demands from parents.


Particular Dissatisfaction with Administrative and Documentation Complexity

  • Pediatricians complain about the growing burden of complying with Meaningful Use, more demanding pre-authorization requirements, and other administrative hassles. Among these issues, struggles with electronic health records (EHRs) stand out as being particularly frustrating for pediatricians.


To continue reading this article, visit athenahealth or click here

Simple Steps to Improve the Patient Waiting Room Experience


We recently spoke with Melissa McCormack, a medical analyst at medical software resource website Software Advice, about data she collected surveying 5,003 U.S. patients to determine what would decrease their frustration with doctor’s office wait times.

  • Just how long are patients typically waiting to be seen by a doctor?

"Research indicates the national average is around 20 minutes. Among patients we surveyed, 85 percent are seen within 30 minutes, and 45 percent spend less than 15 minutes in the waiting room. Unfortunately, 15 percent are waiting more than 30 minutes. It’s telling that despite the fact nearly half our respondents wait less time than the national average of 20 minutes, a full 97 percent still say they’re frustrated with wait times." 

  • So, patients are waiting too long, and they’re frustrated. Do you see any way doctors could monetize this opportunity, perhaps by charging a small fee for an expedited service?

"We did ask survey respondents if they’d be willing to pay for faster service. But only 22 percent of those we surveyed said they would consider paying a small surcharge to visit their physician more quickly, so it’s not likely. Our takeaway is that patients expect outstanding service to be the norm, not a premium offering that would come with a surcharge." 

  • Are there any waiting room amenities that might help with patient frustration?

"Yes - 64 percent of patients surveyed said a TV could improve the stay, and 60 percent indicated that free WiFi would enhance the experience, as would complimentary drinks and food." 

  • What were some of the more unusual findings from your survey?

"I was surprised to find that the most effective fixes for patient frustration were free. For example, a simple apology from the doctor would decrease annoyance for 70 percent of patients; and if warned in advance how long their waiting room stay would probably be, 80 percent of patients would be less irritated."


Please click here to see the full Software Advice report.


Hot Trends for 2014: Care Collaboration and Coordination Top the List



In this article, Nancy Finn shares some exciting new trends that will advance participatory medicine in 2014.

  • New models of care such as the patient-centered medical home with a “whole person” orientation that designs care around a health team that coordinates care and brings the patient into the decision process will be one of the dominant trends.

  • Meaningful Use Stage 2, the statute that shifts payments to clinicians from a fee for services to performance or value-based compensation takes effect. This includes requirements that providers must electronically enter orders for in-patients and electronically write prescriptions as well as give patients access to their health data.

  • Communication Technology is going to be pervasive in 2014. More and more sophisticated mHealth apps will roll out, including apps that offer simple, unidirectional tips via text messages and reminders, to sophisticated, bidirectional apps that track patient vital signs and interact with electronic health records (EHRs) and communicate information back to the providers for evaluation and action.

  • In 2014, patients will use their smartphones and tablets to ask their doctors questions, make appointments or get medical test results, access information in their electronic health record, and monitor their health. Physicians will use their smartphones and tablets chiefly for a number of apps that help them keep current on prescribing, safety information, and best practices.

  • Social media in 2014 is going to transform how doctors and patients interact with each other. For example, doctors will increasingly use options such as Google Hangouts, as an innovative economical way for them to deploy technology to connect with patients and set standards for a transparent, patient-centric model of healthcare that helps them capture and resolve patient issues and increase loyalty and satisfaction.

  • Population health: The ongoing systematic collection, analysis, and interpretation of data, closely integrated with the timely dissemination of this data to those responsible for preventing and controlling various disease will be another hot button in the health care world of 2014. Enabling tools are available that allow researchers to aggregate information from multiple sources to track disease clusters in real time.  More disease surveillance programs that identify and take actions on outbreaks for strep, whooping cough and bacterial meningitis, hepatitis and many other diseases will emerge this year.

  • In 2014 hospitals will increase their use of wireless sensing, radio frequency identification (RFID) and near-field communication (NFC), barcodes that help these institutions move toward safer, more efficient and intelligent hospitals.

  • Retail Clinics and Health Kiosks will get a boost in 2014. Retail clinics, typically are located in pharmacies or in shopping malls, offer quick easy access to patients for treatment of colds, flu, sore throats, minor cuts and bruises, monitoring of blood pressure and blood sugar, injections and other medical conditions that can be treated on the spot and generally cost no more than a co-pay. Many payers will now cover treatment delivered by a Retail Clinic. Kiosks that are in pharmacies and shopping malls, airports etc. enable people to get basic vital signs read and allow them to connect with an online doctor for quick advice about a medical condition at a low price point.

To read the original version of this article click here or visit

Helpful Hints for Healthy Holiday Eating


Helpful Hints for Healthy Holiday Eating

It’s that time of year again. Holiday parties and family gatherings can present a special challenge when it comes to eating healthy – especially for people who are trying to prevent or control diabetes. The key to a diabetes-friendly gathering is having a variety of healthy food selections. And this doesn’t mean that you’ll have to completely sacrifice all of your favorites!

The National Diabetes Education Program (NDEP) has a few tips to help you stay healthy and enjoy the holidays:

  •  Eat a healthy snack before leaving home. This will reduce the risk of overeating at the party.

  •  Go to the party with a plan. Check out the buffet first, and then decide what and how much

    you will eat. The foods you select should fit into your meal plan.

  •  Bring a dish. Contribute your favorite healthy dish to the holiday buffet.

  •  Savor every bite. Eating slowly reduces your chances of eating too much.

  •  Drink water. Water is a healthy, no-calorie beverage. (Compared to one cup of eggnog that has 342 calories!)

  •  Trim the fat from the meat. Each tablespoon of fat you trim off contains 100 calories.

  •  Be the life of the party. Stay active by focusing on party activities instead of the buffet table.

    If you’re throwing the party, here are a few additional ways to be a healthy holiday host:

    •  Offer a variety of low fat, high fiber foods. There are lots of healthier options – consider fresh fruits and vegetables, nuts, grilled or broiled lean meats, fish, turkey, and chicken without the skin. Reduce the use of mayonnaise, oil, and butter. Increase fiber with whole grain breads, peas and beans.

    •  Serve healthy alternatives to traditional holiday dishes. Transform traditionally high fat and high calorie foods into low fat healthier versions. You can use nonfat or 1 percent milk instead of whole milk or cream. Try to bake or broil foods when possible instead of frying. Skip cream cheese and try low fat cottage cheese or plain yogurt.

    •  Be a support system for your family members and friends. If you see them slipping, keep encouraging them to eat healthy during the holiday season, and throughout the year.

    •  Order a free Recipe book and Meal Planner Guide by calling NDEP at 1-800-438-5383.

      To find out more about preventing and/or controlling diabetes, call the National Diabetes Education Program (NDEP) at 1-800-438-5383 or visit

Sneak Peak: “15 Surprising Trends Changing Healthcare”

AmyT from Diabetes Mine has provided us with a sneak peak of the new book, ePatient 2015: 15 Surprising Trends Changing Healthcare." In the intro, authors, Rohit Bhargava and Fard Johnmar write: “The goal of this book is to share 15 trends that are poised to fundamentally change the way health and medical care is delivered and received in the near future. Rather than focus primarily on new technologies, our approach is decidedly human-centric. We look at how people will start to think and act differently in health and position technology as an enabler for some of the changes to come.”
To view the originial version of the article, click here

Make Your Holiday Healthy By Managing Holiday Stress



Make Your Holiday Healthy By Managing Holiday Stress by Mehmet Oz, MD


You might feel pressured not to admit it amidst all the cheer, but let’s be frank: Holidays can be stressful. Whether it’s buying gifts, dealing with unruly relatives or resisting cravings, the hype can leave you feeling exhausted and overwhelmed. Fortunately, you can stay both healthy and happy during the holiday season by mastering these common seasonal challenges. To continue reading, click on link docs/13.pdf.


Original version at

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