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ICD-10: One CMIO Questions Its Value

December 9, 2014
by Rajiv Leventhal
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During “roundtable” discussion, experts discuss what lies ahead in regards to ICD-10
Jed Rosen, M.D., CMIO, Carroll Hospital

Healthcare providers and physician groups are spending hundreds of hours and millions of dollars in preparation for the switch from ICD-9 to ICD-10.  For those smaller medical practices and physician groups that don’t have the means to hire consultants and spend a vast amount of resources to manage the changeover, they are turning to their associations for help.  

Undoubtedly, it’s a very hot topic among healthcare associations as their members navigate the complex process in anticipation of the current Oct. 1, 2015 implementation deadline. The Healthcare Billing & Management Association (HBMA), for one, is a nonprofit trade association dedicated to healthcare revenue cycle management, and is working with its members—medical billing companies— to develop best practices and contribute meaningful dialogue in preparing for ICD-10.

HBMA’s most recent ICD-10 readiness survey, taken this fall, revealed that its members are getting increasingly confident in their system’s capability to handle both ICD-9 and ICD-10 concurrently. On the other hand, 23 percent of respondents reported that system updates are not complete, and 37 percent of those that have not completed updates have no scheduled time for completion. As a result, internal testing is still lagging, the survey found.

Since then, there has been no shortage of controversy surrounding the transition to the new coding set. Recently, a number of medical groups urged Speaker of the House of Representatives John Boehner (R-OH) to include a provision in an upcoming bill that would delay the ICD-10 compliance date another two years. Meanwhile, last month, the Coalition for ICD-10 sent a letter to House and Senate leaders urging them not to delay the ICD-10 implementation date again.

HCI Associate Editor Rajiv Leventhal recently spoke with various HBMA members and others about this ongoing debate, asking them about the level of preparedness that they’re seeing, as well as the industry’s overall take on this mandate, and what lies ahead. Included in this discussion are: Andre Williams, executive director, HBMA; Brian Langerman, executive director, InSight (a user group for McKesson customers); Dr. Jed Rosen, M.D., chief of surgery and CMIO at the Westminster, Md.-based Carroll Hospital; and Jeanne Gilreath, HBMA president.

What trends are you noticing in organizations’ readiness for ICD-10?

Gilreath: The additional time has given our membership time to prepare and our readiness rates have gone up considerably. The combined “somewhat confident” to “very confident” response is now in the 97 percent range. There is a difference between “somewhat” and “very,” but the fact of the matter is we have had more time to work with vendors, providers, coding staffs, and even payers to determine that readiness.

Rosen: I agree. We started a much more formal education process with our providers so that we were really prepared for the additional documentation requirement that comes with ICD-10.

Are vendors and payers more ready than providers, as recent research might suggest?

Langerman: Providers aren’t as ready as the vendors. They don’t have that mass of weight to get someone to approach that, and at InSight, we want to be that mechanism between the vendor, Mckesson, and the individual users to get them individualized education. Physicians are up to their elbows in several other things, including meaningful use and other mandates that they’re dealing with in today’s healthcare, so they have pushed ICD-10 to the back burner because no one was really helping them on an individual basis. And that’s what we’re trying to do. But ICD-10 is an increased level of documentation from the doctor’s view.

Brian Langerman

From a financial standpoint, did folks feel hamstrung when the delay was announced?

Langerman: From a funds perspective, we have heard from people that operational funds could have been spread out from a planning perspective over multiple years had they known there would have been a delay. From a planning perspective, we heard that folks who took it seriously, who were planned and ready, were working with vendors on the actual work plan and strategy for implementation. So even with the delay, those people were prepared for some remediation. From a vendor standpoint, they already planned out schedules, so the delays bottlenecked things more because their schedules were already pushed to the limit in terms of what they could do.