Lynne Thomas Gordon, CEO of AHIMA

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Mark Masselli: This is Conversations on Health Care. I a m Mark Masselli.

Margaret Flinter: And I a m Margaret Flinter.

Mark Masselli: Well , Margaret, stand to the wire, just a few weeks left for open
enrolment on the insurance exchange.

Marg aret Flinter: Well, that’s right, Mark and roughly a million more Americans
signed up for insurance on the exchanges in February, that brings the latest
count to 4.2 million enrollees, still short of what the administration have wanted
which was close to 7 million by the end March of this year.

Mark Masselli: Then the other number that’s fallen short as well is the so called
young invincible s only about a quarter of those who have signed up for insurance
on the exchanges are between the ages of 18 and 34 .

Margaret Flinter: There is still some remarkable numbers to note despite some
of those shortfalls. Close to a million people have signed up for coverage on the
California Exchange alone and about a quarter million new enrollees in New York
State, so t here are pockets where the healthcare was really having a huge
impact.

Mark Masselli: Should be noted, the administration is really targeting those
young invincibles and we will see how that works as we draw close to the end of
the March.

Margaret Flint er: Some states are looking into the possibility of extending open
enrolment for another month. Oregon is one, their exchange has had problems,
functioning perfectly. Likely, it won’t be fully operational during this time period,
so they are hoping for a nother month from the Obama Administration and I think
Nevada and New Mexico are asking for more time as well.

Mark Masselli: In - spite of these problems, we could look at the glass is half full,
there are now millions of Americans who are covered by heal th insurance and
millions more who are covered under the Medicaid program and that’s bound to
have a positive impact on the population itself over time.

Margaret Flinter: Because once these folks get into the healthcare system, Mark,
hopefully they will be able to get both prevention and timely treatment for their
health concerns and each of those health concerns come with their own
diagnosis cost. So our guest today is an expert on health information
management and medical coding. Now, most patients an d our listeners won’t
notice a big change come back to over first but there are big changes in store in
something called the ICD - 9 to ICD - 10 conversion, a new coding system that is

more complex but also is going to give us much better information on the st ate of
health of people.

Mark Masselli: Lynn Thomas Gordon sees over the American Health Information
Management Association. She is going to fill us in on this switch to ICD - 10

Margaret Flinter: Lori Robertson, Managing Editor of FActCheck.org is goin g to
step by uncovering misstatements made about health policy in the public domain
and remember, no matter what the topic, you can hear all of our show by going to
CHC Radio.

Mark Masselli: As always, if you have comments, please email us at CHC Radio
o r find us on Facebook or Twitter, we love hearing from you.

Margaret Flinter: We will get to our interview with Lynn Thomas Gordon in just a
moment.

Mark Masselli: But first, here is our producer Marianne O’Hare with this week’s
Headlines News.

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Marianne O’Hare: I am Marianne O’Hare with these healthcare headlines .
Backing off on Medicare Part D, the Centers of Medicare and Medicaid is
withdrawing part of its proposal for sweeping changes to the Medicare
Prescription Drug program. Marilyn Ta venner of the Centers f or Medica id &
Medica re is saying, they listen to concerns from both sides of the isle as well as
stack - holders in the medical and patient communities, who came out strongly
against those changes. The CMS plan would have limited numb er of plans
insurers could offer customers and greatly limit the drugs available to Medicare
Part D consumers. CMS heard from numerous stake - holders in the patient
community, pharmacy world, and politicians from both sides of the isle crying foul
over tho se changes.

The White House is doing a full - court press to aim up enrollment in the insurance
st
exchanges before open enrolment ends March 31 . The so called Young
invincibles have not turned out in numbers they had hoped. Of the 4.2 million
who have sig ned up for health coverage under the Affordable Care Act, only
about 25% are in that coveted 18 to 34 year old group. So in addition to hiring
thousands of new folks to help process the insurance sign ups, they are taking to
the airwaves as well, advertis ing on shows popular among the millennial
generation. President Obama even appeared on actor Zach Galifianakis’
interview show parity Between Two Ferns to reach that target audience.

New weapons on the AIDS upfront, scientists have proven a newly develop ed g el
can have a prophylactic effect against AIDS transmission, even when

administered after intercourse has occurred. Scientists at the University of San
Francisco revealed monkeys given a gel containing Raltegravir , an FDA
approved drug for HIV, only on e in six monkeys contracted HIV in the gel group.
In a placebo group, all monkeys became infected. And another study showed
that when uninfected partners are given a low dose of antiretroviral drugs, it
could inhibit transmission of the virus from infect ed partners.

Crohn's disease affects some million Americans who must suffered the pains in
the indignity that a company that’s testing all this order which seems to start with
an overacted immune system causes abdominal pain, diarrhea, b l eeding, weight
lo ss and other symptoms. Many patients have to take powerful steroid s which
have their own side - effects . Mounting evidence had suggested that microbes
living in the gout might contribute to the problem . A study at M ass General
look ed a t the gout microbes of 1500 Cro h n ’s patients and found in abundan ce of
bacteria that cause inflammation , and a lack of the microbes that counterbalance
that reaction . They suggest they need to more to find super pro - biotic to balance
out those intestine of C rohn’s patient . I’m Marianne O’Hare with th e s e
healthcare headlines.

Mark Masselli : We’re speaking today with Lynn Thomas Gordon, the Chief
Executive Officer of the American Health Information Management Association or
AHIMA, the premier association of health informatio n management professional s
worldwide . AHIMA is working to advance the use of electronic health records in
its one of the four cooperating parties responsible for the ICD - 10 coding
guidelines . Miss Thomas Gordon was also Chief Operating Officer of the
Chil dren ’s Hospital of Michigan and was a member of the information
management t a s kf orce of the joint commission . S he earned her Executive MBA
at Georgia State University . Miss Thomas Gordon , welcome to Conversations
on Healthcare.

Lynn Thomas Gordon: Than k you.

Mark Masselli: CMS administrator , Marilyn Tavenner , who has been on the show
with us before, recently announced there would be no delay this year in the
October first transition date for switching t o ICD - 10 co de standards in healthcare
th
and it ’ s fo rmally known as the 10 addition of the International Classification of
Diseases , and many further listeners , L ynn, who aren’t familiar with the nation ’ s
system of healthcare coding, c ould you give us some history of the evolution of
the coding system and how it drives healthcare system s .

Lynn Thomas Gord on : T o begin with , ICD - 9 is really a coding classification
system , so why do we have it ? Well, it really allow s for our healthcare providers
to interpret mor tality and morbidity data t hroughout the worl d . I like to compare it
to a bar - coding system in a grocery store . S o think for it in vegetables , for each
have one code , vegetables have another . W ell , it’s the same with ICD - 9 except
th at rather than encoding p arties, you are really coding diseases an d procedures ,

and believe it or not , this system was develop ed in the United states in 1979 ,
some 3 5 years ago , and if you just look at our i Phones today which we never
even heard of that long a go , w hile healthcare has also had many, many changes .
A nd so , the diagnosis code we’re using and procedures code are specifically for
hospitals inpatient services . S o although the coding for statistic s and research
with the original function of the system s, in 1983 , ICD - 9 became the way that we
communicate with inf ormation for the purpose of re imbursement, s o we use this
system for many, many reasons . A nd in early 1990 s, we s a w the need to
replace ICD - 9 and actually , it was brought up by the National Committee on Vital
and Health Statistics, and they basically said that ICD - 9 is rapidly being outdated ,
and they recommended at that time that we move to ICD - 10 . A nd as we know ,
we have been very slow to move to this update d version and believe it or not,
today, we are the only industrialize d country not to be on this new system.

Mar garet Flinter : I think this is one of those interesting issues in healthcare
where people might be looking at it on a very business bureaucratic practice
management bas is, but for everyone who is really interested in population
management a n d public health , it really provides us an incredible window . S o tell
us from that sort of broader health perspective, what’s really different, what does
it mean to have a new classification system , and maybe we can take one or two
conditions , asthma or high blood pressure or anything that you would like to
speak to.

Lynn Thomas Gord on : Well , this updated coding system is really going to help
us to drive improvements in qua lity and reducing cost which we know, healthcare
is a big cost to our country , an d also really looking at our communit ies and how
come we improve to help in our communities and what we are saying is that it’s
really more granular, it’s more specific . A nd so by having th at additional
information , it’s really going to be able to help us get out of this antiquated
system and look at things differently . Sp ecifically , I think most people would think
if you go in to the hospital and break your leg, that you would know it ’s left or
right , but we don’t that now with ICD - 9 . W ith ICD - 10 , we’ll all be able to look why
they are at the case, so there is an example for you .

Ma rl Masselli : Lynn, y our organization AHIMA is one of the four organizations
chosen by CMS , the Center for Medicare & Medica id t o assist practices in
making th e switch over and some have talk ed about this in the same way that we
talk ed about changing over computer systems at the turn of the century here in
st
21 century , Y2K thread that we had, but, tell them , how complex you think this
will be and who are some of the other organ izations as well who are working on
this and what’s involve d that making the transaction to ICD - 10.

Lynn Thomas Gordon: Well, there are just a lot of m oving part. And you cannot
change over this new system in a couple of days or even a couple of week s ,
the re really needs to be a concerted plan n ed effort to understand if you are a
healthcare provider , everywhere , coding it’s being used , a nd you need to make

sure that all the systems depending on code s are updated appropriately, and
then , in addition , the staff who a s sign co des, they have to be tr ained on this new
system. So, it’s not that something you just say, o h, I know how to do ICD - 9,
now, I know how to do ICD - 10 . The re really do es need to be training. And it
impacts basically anybody that deals wi th heal th care provider s , payers, vendors ,
contractors , physicians . So, there is a lot involve d in switching the ICD - 10 and
you ask ed what’s involve d, ther e needs to be use r training s, we need to upgrade
our systems , and one of the se thing s, many healthcar e provide r s are doing,
many people are reaching out to their physicians and working with them to make
sure that they have the b est clinical documentation available which is then used
to assign each code.

Margaret Flinter: Lynn, let’s talk about some of t he op position , who ’s arguing for
keeping the status quo and I guess, that might also, I don’t think we quite s aid it
directly , there is the cost of making the trans i tion but the big fear is about
whether, your revenue is going to be impacted after October or when maybe you
could address both of these things first.

Lynn Thomas Gordon: Well, first of all , there is just opposition because it ’ s
change d, th at we a re human , and we want to resist this. In addition , I think as
you know, healthcare is very comple x. And as you mention ed, it’s not a fun to
mandate. So, despite all that , we a t AHIMA, and many, many others
sta k eholders feel that the long - term benefit s of having a more robust encode
coding system f a r out weight any of the p ushback we are getting. We do know
that it ’s something that is needed , it’s been needed for a long time , and it’s
al most obscure to know that there is so much going on in healthcare that we
can’t code for today.

Mark Masselli: We are speaking today with Lynn Thomas Gordon , Chief
Executive Officer of the American Health Information Management Association or
AHIMA, the premier association of health information management professionals
worldwide. AHIMA is one of four cooperati ng part ies responsible for the ICD
coding guidelines. Ly nn , with the transaction to ICD - 10 in October , we ’ re going
to be quadruple in the number of medical codes available to be used by the
heal th care system and its stand to reason that there might be some bottles being
pop ped in research centers , who are going to have a lot more detail ed population
health data to min d thi s result and you are just talking a little earlier about those
who are opposing, but there have to be a lot of people who are very excited
about these, maybe w al k t hr ough the other advocates ou t there, who had been
finding a way for this conversion to happen.

Lynn Thomas Gordon: I think a huge benefit of changing systems will be for the
research community , and the reason for that is because the new codes do allow
for more detail , and if you go back to my g rocery store nowaday s , if you we re
someone that work in a grocery store and you were looking back at everything
you s e l l re tros pectively or anything you want ed to order in the future , you would

probably prefer to know that w asn’t just extrude that you need to look at but a n
apple or even more specifically , a red delicious apple. So, we , definitely in
healthcare want the l a ter , we want that greater specificity. A nd so , I think ,
commonsense just tells us why having this much more robust system w i ll
immensely help res earchers and other s, when they are studying population
health.

Margaret Flinter: Well, then , you -- would you are seeing in healthcare to be
particular riding the w ave of a sea of changes ? Electronic health records, you
know, more than halfway , they are on the practice side, hospitals , I think a re
about 80% trans i tion ed over but, also coming right at this, the HIPPO 5010
requirements are going to be taking effect , a new diagnostic and statistic manual
of mental disorders or DSM , s o , lot s of change, lots of platforms , and of course ,
they all int er relate s. F rom your p e rspective , how do all of these things interrelate
and quite frankly , how do they all complicate things ?

Lynn Thomas Gordon: Well, I think as I said before , we do have a lot going on in
the healthcare sector . A ctually 5010 is very important because it makes the way
for ICD - 10 to be transmitted to payers and as for DSM - 5, psychologist will
actually need to have familiar ity with ICD - 10 because even when using DSM - 5 ,
the i r diagnos i s must be reported in terms of ICD - 10 codes in order that they can
get paid for their services.

Mark Masselli : Lynn , I should have ask you this earlier, AHIMA, will you tell us
what the other work s that you’re engage d in around the world , and h ow is it
structured ? Who is the member of AHIMA and how long has it been around?

Lynn Thomas Gordon: AHIMA , we ha ve been around , believe it or not, for 86
years. We’ve over 71 thousand member . We do have global member s as well
not as many , b ut in the United States, a huge organization, many people working
in across the healthcare sector , a nd probably 60 different job types and up to 40
different setting.

Margaret Flinter : Wow, It’s a pretty complicated organization and I would
imagine there is some f uturistic thinking going on as well as people write that se a
o f changes , there is also the need to look for and I’m thinking about two areas ,
and just be ing interested in you r speculation on this. One , you know, ICD - 11
coming up possibly , and what’s the, the though t around including much more of
the social determin ants of he a l th right ? So we know that low income or low
literacy level , low education , all of th e s e thing s have an impact , and h ow do you
envision this becoming part of what we c ode in the futur e , and I guess , the
second part of that speculation about the future, you anticipate that the advance
or personalize d medicine and genomic medicine will lead to another need to do
a, a major upgrade in adaptation ?

Lynn Thomas Gordon: I think that a reall y good question . A nd what we want to
make sure is that, as we ad o pt or develop actually, and then , ad o pt ICD - 11 that
we make sure that we consider all of the things that you mention ed . Right now,
the World Health Organization is developing ICD - 11 and the wonderful thing
about that is that they’re actually utilizing a web based platform that allows
experts and everyday users to participate in the revision. So as they learn ,
where things are happening and what’s important to ask , when we look at
population or community health, they can include those in the final output. That
is being revised to really better inside the progress and help finances in medical
practices. So yes, I predict that anything from personal genome information as
well as other things that are important to us, as healthcare providers , will be
included. To me , it’s just so exciting that mo r bi d ity and mortality classification
information can be collected across the globe, so that out patients and healthcare
organization s, we can make sure that we achieve the triple aim which is to dr ive
down cost s , improve community health , and of course the most important thing ,
really looking at the quality the care we will see.

Mark Masselli : You are absolutely right. I want a pick up on that first o ne of cost .
C ertainly , you’re not going to get reimburse d if in November , you’re not using
ICD - 11, is that true ? F or those practices that are out there, what happens to
people who don’t make the conversion?

Lynn Thomas Gordon: We ll, we -- yes, we need to have that coding system in
st
place to get reimburse d because it’s October 1 , it is a go. And so we’re
encouraging anybody that ’s using the coding system for reimbursement to make
sure they’re doing dual coding, beginning in July , so they can start bein g very
comfortable with it so that when that October first date come s around, they can
push those bills out of the door with no change except changing the delivery
system. So it will be easy and it will be very comfortable to their st a ff.

Interviewer: W ell , I think we’ve a lot of interesting things to look forward to. On
October 1, we’re just wrapping up our first couple of month of the intense focus
being getting people insurance in the first place s o that they can get the care and
we’ll move onto the ICD - 10 implementation shortly. We’ve been speaking today
with Lynn Thomas Gordon, Chief Executive Officer of the American Health
Information Management Association or AHIMA , t he premier association of
health information management professional s worldwide on the upcoming
transition from ICD - 9 to ICD - 10 coding in the healthcare industry. You can learn
more about their work by going to ahima.org that’s A - H - I - M - A .org. Lynn , thank
you so much for joining us on Conversation s on Health care today , and good luck
separating us all into this transition.

Lynn Thomas Gordon: Thank you so much.

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Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about Healthcare R eform and policy.
Lori Ro bertson is an award - winning journalist and managing editor of
FactCheck.org, a nonpartisan, nonprofit consumer advocate for voters that aim to
reduce the level of deception in U.S. politics. Lori, what have you got for us this
week?

Lori Robertson: Well , Senate Majority Leader, Harry Reid, wrongly blamed the
conservative group Americans for Prosperity f or promoting a false story of a
wom a n who s aid her insurance premium s went up $ 700 per month . AFP didn’t
actually feature that wom a n ’s story in any of it s ads. In a floor speech, read was
highly critical of brothers , David and Charle s Koch , owner s of the o il and
manufacturing company , Koch I ndustries and major funders of American s for
prosperity , a 501C4 founded by David Koch . T he group is behind a lot o f
advertising against the Affordable Care Act , re ad cited two stories , h e s aid were
untrue and being promoted by American s for Prosperity a d s , but only one was i n
AFP ad. H e went on to say that Republican s were making up stories out of
“w hol e cl oth” but n either of his anecdotes was fabricated . T hey had some basis
in f a ct . T here was woman in spoken who said her and her husband ’s premium s
were going up nearly $ 700 a months . I t turn s out that was one option given to
her by her insure r w hile another option would have been $ 500 more and she
acknowledge d that she could probably save more on the s ta t e insurance
exchange , but we didn’t go on the website . R e i d ’s other example was feature d in
AFP ad in which a leukemia patient from Michigan s aid her insurance was
cancel led and her new plans out of pocket cost were unaffordable . S he later told
the Detroit News that her new premium were 50% lower and the newspaper
found she would save at least $ 1200 a years on her new plan even if he r out of
pocket expenses reach t he plans maximum , but still Reid went way too far in his
claims about AFP and the stories the group has promoted , and that’s f act c heck
for this week . I’m Lorry Robertson , Managing Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country's major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact, that you would like
checked, email us at Chcradio.com, w e will have FactCheck.org's Lori Robertson
check it out for you here on Conversations on Health c are.

Mark Masselli: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. The U.S. boost
among the highest rates of t een birth s in the world’s industrialized nations. And
while those numbers have been declining in recent years, it's still a significant
health issue in this country. According to a recent study, the decline in teen birth
rates in this country can be attr ibuted in part t o the launch of the popular MTV
show 16 and Pregnant and the subsequent Teen Mom. MTV launch ed the
series in 2009 to show the challenges and harsh realities of teen pregnancy and
teen parenthood.

Researchers at the University of Maryland and Wellesl e y College conducted an
e mpirical study to determine what , if any , impact th e show has had on the decline
of teen pregnancy and birth. Wellesley College Economist Phillip Levine decided
to utilize Google Data Tracker and Twitter activity around the airing of the shows
which develop ed a loyal following and consistently higher ratings since th e show
began in 2009.

Phillip Levine: We love to see people searching for things like how do I get birth
control , and it's remarkable how people respond to the show , do things like tweet
and search about things that they are watching on TV as they are watching it and
immediately following. So you see these enormous spikes in activity about 16
and Pregnant , t he day the episode airs .

Mark Masselli: More int erestingly , where the social media conversation s
surrounding themes explored on the show, lo s s of freedom, the father s of the
baby often removing themselves from the picture , themes that really drove the
challenge of teen motherhood , home to billions of yo ung vulnerable viewers.

Philip Levine: So the important point about watching this show is that it really
illustrates the life choices that these girls have made a nd what outcomes it has
on their lives .

Mark Masselli: Based on the data they compiled, th ey determined the show led
to a 5.7% drop in teen births from 2009 to 2012, a significant number in the
relatively short period of time. The study can be found in the National Bureau of
Economic research. MTV says this aligns with their goal of the show which was
to utilize their trusted media platform to reach a vulnerable sector of their
audience , a media out let utilizing airwa ve s to reveal the risk of teen pregnancy ,
thus creating in a platform for dialog for teens to address this potentially life
chan ging event , leading to a significant reduction in teen pregnancy, now that’s a
bright idea.

Margaret Flinter: This is Conversations on Health c are. I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli . Peace and health.

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Conversations on Health c are, broadcast from the campus of WESU at Wesleyan
University, streaming live at Wesufm.org and brought to you by the Community
Health Center.

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