In April, Congress and President Obama agreed to delay implementation of the ICD-10 standard for medical diagnosis and billing codes to Oct. 1, 2015. A study conducted in May and June found that most healthcare providers are using the 12-month ICD-10 reprieve to prepare for the new coding standard.
The survey of 349 healthcare organizations, vendors, and consultants conducted by eHealth Initiative and the American Health Information Management Association (AHIMA), and sponsored by the health IT vendor Edifecs, found that organizations are taking advantage of the delay in a variety of ways. For example, 61% are using the extension to train more staff; 60% are improving documentation integrity; 47% continue dual coding; and 40% are conducting more robust testing. Only 33% have reallocated resources.
Some observers have questioned the effects of the delay on the healthcare organizations that were working to meet the previous deadline, Oct. 1, 2014. To mitigate productivity loss, 68% of survey respondents plan to conduct extra training and practice, and 31% expect to hire more coders to help with the eventual transition.
[Regulatory requirements have gone from high priority to the only priority for healthcare IT. See Healthcare IT Priorities: No Breathing Room.]
By the end of this year, 40% expect to begin end-to-end testing; 25% plan to start this process by the end of 2015. Of the organizations that aren't planning end-to-end testing, 41% claimed no knowledge of how to perform testing.
"If you were training for a marathon and the race was delayed, you probably wouldn't sit on the couch eating potato chips," Lynne Thomas Gordon, CEO of the AHIMA, said in a webinar presentation of the study results. "We are telling everyone to keep the momentum going. Don't stop. Maybe just slow down, but keep the momentum going."
Webinar panel attendees -- including AHIMA and Edifecs executives, plus a representative from the Centers for Medicare and Medicaid Services (CMS) -- cautioned that each ICD-10 delay has multiple effects. Executive buy-in wanes as healthcare organizations lose the sense of immediacy around ICD-10. Students are concerned about the viability of their new skills. And healthcare organizations reallocate ICD-10 funds to new health IT initiatives.
Delays are expensive, too. A one-year ICD-10 delay would increase costs between 11% and 25%, according to 50% of respondents; another 37% fear costs would increase 50% if the coding change were delayed 12 months. A two-year delay would be "potentially catastrophic," 69% of those polled said.
Denesecia Green, senior health insurance specialist at the CMS, said during the webinar that her agency wants to ensure the coding change continues to advance to avoid increased costs and build on healthcare organizations' ICD-10 adoption progress. For one thing, the delay has already cost her organization; it was fully prepared for an October 2014 rollout of ICD-10 but had to recode systems for ICD-9.
"Part of our effort to align industry and regain that momentum is bringing everyone to the table to develop a national ICD-10 timeline," she said.
The CMS will centrally locate information on partners' ICD-10 testing dates, Green said; it already has 90 partners lined up. The agency also will publicly share partners' information on when they are providing supporting materials, training, webinars, or other informational offerings to healthcare customers. Likewise, it hopes to share best practices to show how many providers are prepared for ICD-10.
"What is surprising maybe to the healthcare industry overall... is that more people were ready than [some] people actually thought," she said. The CMS is talking to stakeholders about how to "share some of those best practices and stories of how they are moving forward, what tools are they using to do that, and sharing them throughout the whole industry. I think this survey... does validate a lot of the effort and work that has happened thus far."
ICD-10 advocates will continue informing healthcare colleagues about the benefits of the next-generation coding system, which was developed in part with physicians, Green said. Executives agreed that the more detailed coding is vital in this age of data, value-based care, and thinner margins.
"I personally view ICD-10 as a natural extension of Meaningful Use," said Deepak Sadagopan, general manager of clinical solutions at Edifecs. "ICD-10 really adds more granularity and reduces ambiguity... Better communication results in better care for the patient, and that's really what this is all about."
Healthcare organizations must do more than test their software, Sadagopan said. System testing is important, but organizations also must optimize workflows, train users, and prepare documentation to ensure success.
Experts agreed that expanding beyond end-to-end testing should help organizations mitigate any expected revenue damage. In the short term, healthcare providers worry ICD-10 implementation could hurt their bottom line. A mere 6% say ICD-10 will increase revenue, whereas 38% fear revenue will decrease, and 14% say revenue will remain flat, the study found. However, 65% plan to leverage the more specific code set for claims processing and billing; 62% expect to use it for quality improvement; and 51% will use ICD-10 improvements for performance measurement.
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