ICD-10 Delay: An Opportunity To Change Course - InformationWeek

InformationWeek is part of the Informa Tech Division of Informa PLC

This site is operated by a business or businesses owned by Informa PLC and all copyright resides with them.Informa PLC's registered office is 5 Howick Place, London SW1P 1WG. Registered in England and Wales. Number 8860726.

IoT
IoT
Healthcare // Clinical Information Systems
Commentary
8/22/2014
09:06 AM
Dick Taylor
Dick Taylor
Commentary
50%
50%

ICD-10 Delay: An Opportunity To Change Course

Instead of just delaying the new medical coding system, we should be rethinking the necessity of it.

Easy-to-Mock ICD-10 Diagnosis Codes...
Easy-to-Mock ICD-10 Diagnosis Codes...
(Click image for larger view and slideshow.)

Congress, an organization that has elevated kick the can to an Olympic-level sport, has decided to delay ICD-10, an initiative that promises to transform healthcare by solving the heretofore unsolvable problem that our billing systems aren't complicated enough.

IT consultants and vendors are acting like my Yorkshire terrier deprived of his favorite plastic bone. The frantic high-pitched barking has made it clear that this delay is the worst thing imaginable. Sunk costs! Unfair to good organizations! Uncertainty! Sky falling, film at 11! About the only complaint we haven't yet heard is that the slightest bad thing is going to happen to patients or providers.

That's probably because it won't. The transition to ICD-10 doesn't change models of payment or introduce new concepts in medicine. It's really just about replacing an old and worn billing code set with one that is more complicated and less understood. An overwhelming majority felt that the best possible short-term outcome from October was going to be no change -- no major hit to revenues, no major confusion, and nobody going out of business. Given the anxiety we've been seeing lately, with federal and state governments demonstrating a distinct lack of success in the IT area, revenues and margins savagely squeezed for provider organizations, and an industry-wide concern about how ICD-10 was really going to work in practice, most of us weren't betting on the best possible outcome.

[Who's complaining? Read ICD-10: Painful To Implement, Painful To Delay.]

ICD-10 is a diagnosis terminology intended for use in fee-for-service medicine. It's designed to capture distinctions that might make payment differences. It doesn't effectively capture prognosis, diagnostic uncertainty, patient choices, planning realities, or anything else that might drive excellent care. Providers will likely treat it as they did ICD-9, minimizing its use except as needed to support revenue. If you think that multiplying the number of billing codes will help, consider that only a small percentage of ICD-9 codes ever appear in a patient record. Complexity for its own sake has already been considered and rejected by the people who produce the data in the first place.

The American Medical Association (AMA) has been firm in its opposition to ICD-10. So have influential individuals within healthcare, at least if you ask them privately and thoughtfully. That opposition was never about whether better documentation and better reporting would help. The question was whether ICD-10, as conceived and implemented, would make meaningful improvements that are worth the cost.

In early 2014, that cost was looming larger and larger. The HealthCare.gov go-live at a minimum highlighted the perilous nature of large government-driven IT projects. Meaningful Use 2 is by itself stressing organizations more than anyone expected in the early days. Timelines are short and IT projects (electronic medical record replacement and upgrades in particular) have slipped. The ICD-10 go-live on Oct. 1, 2014, was clearly an all-or-nothing, life-threatening event that relied on meticulous IT performance and strong organizational focus. And the deadline was drawing near.

The First Rule of Holes says that when you realize you're in one, stop digging. The ICD-10 hole was growing too large to ignore. So Washington, in a rare fit of sanity, told everyone to put down the shovels.

It's a delay, not a cancellation. We're still in the hole. We're still stuck with too many organizations too dependent on fee-for-service reimbursement. Risk-sharing and accountable care are still really hard to figure out. The people who serve our shared patients -- payers, providers, regulators, and physicians -- still live with historic hostility and regulatory barriers. We can go right back to determinedly digging if we want. In fact, that's still the official plan.

As we lean on the shovel, though, it might make sense that we consider stepping out of the hole. There's no natural law that says we have

Next Page

Dick Taylor, MD, is managing director and chief medical officer of the Advisory Services Division of MedSys Group. Dr. Taylor focuses on integrating IT efforts with the clinical and operational ownership needed to capture permanent and positive changes within healthcare ... View Full Bio
We welcome your comments on this topic on our social media channels, or [contact us directly] with questions about the site.
Previous
1 of 2
Next
Comment  | 
Print  | 
More Insights
Comments
Newest First  |  Oldest First  |  Threaded View
David F. Carr
50%
50%
David F. Carr,
User Rank: Author
8/22/2014 | 10:16:58 AM
Re: Once, twice delayed? Who thinks it won't be delayed again or cancelled?
Thanks for sharing your thoughts, Deborah. I had a feeling you'd have something to say about this.
InformationWeek Is Getting an Upgrade!

Find out more about our plans to improve the look, functionality, and performance of the InformationWeek site in the coming months.

Slideshows
IT Leadership: 10 Ways to Unleash Enterprise Innovation
Lisa Morgan, Freelance Writer,  6/8/2021
Commentary
Preparing for the Upcoming Quantum Computing Revolution
John Edwards, Technology Journalist & Author,  6/3/2021
News
How SolarWinds Changed Cybersecurity Leadership's Priorities
Jessica Davis, Senior Editor, Enterprise Apps,  5/26/2021
White Papers
Register for InformationWeek Newsletters
Video
Current Issue
Planning Your Digital Transformation Roadmap
Download this report to learn about the latest technologies and best practices or ensuring a successful transition from outdated business transformation tactics.
Slideshows
Flash Poll