ICD-10 fails to achieve ARCS in America

Sept. 24, 2014

Here’s a brief history lesson in education: In the early 1980s, John Keller, a professor at Florida State University, develops the ARCS model of teaching. Keller suggests that learners ask themselves various questions that establish how aggressively they may engage with new information or an unfamiliar activity. He groups these questions into four categories: attention, relevance, confidence and satisfaction (ARCS). According to Keller, learners often ask themselves, “Is the new activity interesting? Is it something that I need to learn? Will its outcomes match my goals? Is the desired outcome attainable on my own, or will I need assistance? Will the outcome create new value in my life?” Keller argues that if these questions cannot yield satisfactory answers for the learner, then it is less likely that any new information will be assimilated or used effectively later. In short, effective teachers never answer the question, “Why should I learn this?” with the response, “Because I said so.”

Now here’s a brief history lesson in healthcare: In 1983, the World Health Organization (WHO) begins editing the 10th edition of the International Classification of Diseases (ICD-10) coding system. They complete their work in 1992. Within 10 years, Australia, Canada, China, Netherlands and Sweden transition away from ICD-9 and incorporate ICD-10. In 2003, the U.S. National Committee for Vital and Health Statistics (NCVHS) votes to recommend that the Secretary of Health and Human Services (HHS) move forward to adopt ICD-10. In 2009, HHS publishes a final rule (CMS 0013F 45 CFR, parts 160, 162) in the Federal Register, adopting ICD-10 effective October 1, 2013. In 2012, HHS Secretary Kathleen Sebelius, citing a need for “additional time for organizations to prepare and test their systems,” announces a rule finalizing a one-year proposed delay from October 1, 2013, to October 1, 2014. In 2014, the Protecting Access to Medicare Act of 2014 establishes a ban on the adoption of ICD-10 prior to October 1, 2015. Soon after this bill, the Centers for Medicare & Medicaid Services (CMS) declares the United States will complete its transition to ICD-10 by October 1, 2015, more than 20 years after its initial release. 

When you put these two lessons together, it is painfully obvious that our government’s ICD-10 planning and mandates have been akin to an inexperienced teacher telling students to learn new material, “Because I said so.” Our stagnation is the product of weak government leaders who lack the conviction and persuasive messaging needed to overcome the objections of the special interest groups who stand in the way of the healthcare industry evolving beyond a diagnosis system that was installed when “The Dukes of Hazard” was a prime-time hit. 

Even though it’s a new lesson that few in America want to learn, it’s up to the healthcare community to come together, and in a hurry, to address Keller’s questions in such a manner that our industry as a whole can confidently learn and utilize ICD-10 to its full potential. Otherwise, who knows? October 1, 2015, may be just another year and another so-called deadline that disappears, leaving healthcare to continue languishing in limbo.

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