Healthcare Industry Makes Little Progress On ICD-10

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The healthcare industry is not preparing quickly enough for the advent of the ICD-10 diagnostic code set to ensure a smooth transition to the new coding methodology when it becomes mandatory on October 1, 2014. That's the conclusion of the Workgroup for Electronic Interchange (WEDI) after surveying 778 healthcare providers, 87 software vendors and 109 health plans in February.

WEDI, which advises the Department of Health and Human Services (HHS) on issues related to the exchange of administrative data, compared the results of this survey to a similar poll conducted in February 2012.

Among other things, WEDI found that:

-- About half of the vendors were less than halfway finished with ICD-10 product development, similar to where they were in 2012.

-- Two-thirds of vendors said they planned to begin customer review and beta testing by the end of this year. About the same number said in the previous survey they had expected to do this by the end of 2012.

-- Almost half of the health plans have completed their assessment, and another quarter is nearly finished. This represents moderate progress, WEDI said.

-- Almost half of the insurers expect to begin external testing by the end of this year. In February 2012, all health plans expected to begin in 2013.

-- More than 40% of provider respondents said they didn't know when they would complete their impact assessment, business changes and begin external testing. This finding is essentially the same as in the 2012 survey.

-- Around 10% of providers expected to begin external testing in 2013; half of the respondents said they didn't know when testing would occur. A year earlier, half of the respondents predicted they would begin testing in 2013.

-- HHS's decision to postpone the compliance deadline for ICD-10 from 2013 to 2014 resulted in a shift in project timelines across all entity types.

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Edward Hock, a director of the Advisory Board Co., a healthcare consulting firm, said it would be wrong to draw the conclusion from the survey results that no progress is being made in preparing for ICD-10. "So much has been done by so many," he said.

Even if a provider is ready to move forward on ICD-10, he noted, the vendor or other major payers may not be prepared. "We are seeing groups that are much closer than they were. But very few organizations will be anywhere near large-scale testing by the end of this year."

In the WEDI survey, vendor respondents most often cited "customer readiness concerns" as the reason for delay and/or lack of progress in ICD-10 planning and implementation on their end. That confused Hock, who said he didn't know what vendors might need from their customers to write the software.

Perhaps what is meant, he said, is that vendors "have not been hearing about ICD-10 extensively from their customers until now." Meaningful Use has been a far bigger priority than ICD-10 to most providers and vendors up to now, he noted. But he expects that that will change rapidly over the next 12 months as doctors and hospitals see the ICD-10 deadline approaching.

Why are health plans making somewhat more progress than providers and vendors? For one thing, Hock said, "The health plans want to avoid delays or trouble related to ICD-10 implementation," which could lead to administrative nightmares and bad relations with providers. Also, he noted, "ICD-10 will give the plans greater visibility into their patient population" because the code set is much more granular than ICD-9. That ability to understand and analyze the health status of plan members will be an asset to insurers in the era of population health management and accountable care.

WEDI's report concluded, "Unless more providers move quickly forward with their implementation efforts, there will be significant disruption on Oct. 1, 2014." Hock agreed with that assessment. However, he added, "'Disruption' doesn't mean that providers can't get an ICD-10 claim out the door, but rather that they lose significant dollars around core processes, such as physician education, coder efficiency, denial management or patient access. That's where the real danger is."

Therefore, he suggested, healthcare organizations should move ahead with their assessments of workflow changes and physician training, regardless of where their vendors and payers stand. End-to-end testing should be the ultimate goal, he said, because it can uncover every issue that an organization must face in the transition. So, even if they can't do external testing yet, "organizations should start with what they can do now," he concluded.