I had the opportunity to listen to a prominent speaker on health care last night and he offered many interesting thoughts on the health care system and reform efforts, but perhaps the most poignant was a reference to George Halvorson's work Health Care Reform Now!: A Prescription for Change.
As evidence of how our health care system still is designed around acute episodic care and not management and prevention of chronic disease one need only look at our ICD -9 coding system. There are over 9,000 of these diagnosis codes which include such gems as " excessive crying of infant"--780.92, and "worried well"--v65.5 (formally called "Person with feared complaint in whom no diagnosis was made"). What codes are not present among these 9,000?
No code for a cure
No billing code for prevention
No billing code for health improvement
How about a little credit for getting someone to walk a mile a day or for giving up sweetened beverages or working with a patient to reduce stress in their life? Somehow I think ICD -10 will fall short here as well, just a guess.