ALUMNI PROFILE Sue Bowman (MJ ’11)
Up to code
Sue Bowman (MJ ’11) improves patient care through policy advocacy
When the United States was slow to approve a long-overdue update of an international medical coding system, Sue Bowman (MJ ’11) played a key role in convincing Congress to adopt the new system without further delay—and she credits her Loyola law education with helping her make a persuasive case.
“A big part of advocacy and policymaking is effective written and verbal communication skills,” says Bowman, who is senior director of coding policy and compliance for the American Health Information Management Association (AHIMA). “I can’t say enough about how much Loyola’s MJ in Health Law program improved mine.”
Code for change
Healthcare providers use a global coding system, the International Classification of Diseases (ICD), to identify medical diagnoses for patient recordkeeping. These codes promote high-quality patient care by ensuring completeness and accuracy in medical charts. Because private and government insurers use ICD codes to determine how treatment should be covered and reimbursed, these codes also affect healthcare costs and payment processes.
The 10th revision of the International Classification of Diseases (ICD-10), which had been adopted by most other countries since its creation in 1990, contains significantly more detail than its predecessor, the ICD-9. Rather than simply coding for a fracture in a patient’s forearm, for example, the new coding system notes which arm; the exact location, type, and severity of the fracture; and identification of initial vs. subsequent encounters, among other particulars.
This specificity improves care by creating a much fuller picture of a patient’s disease or injury, medical history, treatment, work and home environments, and other factors affecting outcomes. With the old system, “Data on new diseases and technology, or important clinical distinctions in diagnoses and procedures, could not be accurately captured,” Bowman explains. “That limited the potential to analyze healthcare costs or outcomes, exchange meaningful data for individual and population health improvement, and move to a payment system based more directly on quality and outcomes.”
Still, some physicians and professional medical associations opposed replacing the ICD-9, citing the time, effort, and cost required for healthcare providers to learn and use the expanded number of diagnosis codes. Congress had responded to pressure from these groups by repeatedly delaying implementation of ICD-10.
“A big part of advocacy and policymaking is effective written and verbal communication skills.”
Making the case
While serving as leader-spokesperson for a multi-organization coalition focused on getting ICD-10 adopted, Bowman combined correspondence, Capitol Hill visits, and Congressional testimony to persuade legislators to end delays of the deadline for implementing the new system. The U.S. began using ICD-10 in late 2015, a few months after her testimony to the U.S. House Committee on Energy and Commerce.
Many of the physicians and medical organizations that initially resisted switching to ICD-10 now say they appreciate improved patient outcomes and reimbursements resulting from the increased detail ICD-10 captures, Bowman says. Just as importantly, ICD-10 is flexible, allowing new codes to be added quickly as public health needs change.
The coronavirus pandemic illustrates how nimbly ICD-10 can respond. “COVID-19 codes were implemented on an emergency basis this past year, and they include important specifics like the patient’s personal history of COVID or close contact with people with COVID,” Bowman says.
Bowman’s ongoing work advances AHIMA’s global leadership role in medical coding policy. She advocates among legislators and government entities for coding quality, integrity, and interoperability among healthcare systems and government agencies; analyzes industry regulatory initiatives and trends; and educates her organization’s members on changing federal regulations and policy. She also writes and contributes to white papers, public policy statements, testimony, and articles on coding policy issues.
Bowman started her career in health information management and was in her current role at AHIMA when, looking to enhance her existing policy expertise and improve her communication skills, she enrolled in Loyola’s MJ in Health Law program. After graduation, Bowman’s new competencies netted her a promotion, a raise, compliments from government agencies, and a successful side business consulting with the U.S. Department of Justice on medical fraud cases.
Bowman particularly credits presentation skills she honed during her Loyola thesis defense with helping to convince the house energy and commerce committee to greenlight implementation of ICD-10. Her calm, composure, and credibility, she says, “really helped persuade the committee.” –Gail Mansfield