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ICD-10 Two Months In: For Providers, a Transition that Finally Came (and Went)

December 16, 2015
by Rajiv Leventhal
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Editor’s note: For the first part of this story, published last week, Healthcare Informatics also interviewed various industry consultants on what they’re seeing and hearing from their provider clients regarding the transition. That story can be read here.

For many patient care organizations nationwide, there was much concern leading up to the ICD-10 implementation deadline of Oct. 1, 2015. Indeed, since the Centers for Medicare & Medicaid Services (CMS) delayed the deadline for the transition to the new coding set three times previously, providers were justly unsure if all of their preparation and resources put into the conversion would go for naught once again.

Nonetheless, organizations such as the Maitland, Fla.-based Consulate Health Care, the largest provider of senior healthcare services in the state and sixth largest in the nation, specializing in post-acute care for more than 200 centers nationwide in 21 states, couldn’t take any chances—they had to be as well-prepared as possible. “We hardly just started our planning,” says Consulate CIO Mark Crandall, referring to the weeks and months leading up to Oct. 1. “We have grown through acquisitions, as many companies do in long-term care. So we have disparate systems that are responsible for forming and submitting data to CMS. We have to double test. There was a lot of preparation that went into that conversion. It’s been a process since the first announcement that the deadline would be Oct. 1,” he says.

Crandall says that a priority at Consulate was making sure that once the ICD-10 switch was flipped, that everything from a system standpoint would continue to flow as it was needed. “We learned a lot from the preparation because our business analysts and our project managers worked with our operation partners to figure out what were the most used ICD-9 diagnosis codes in our care centers. That gave us an idea of what the training would look like,” he says. “Although everyone talks about how many codes there are, we really needed to get a targeted look at the codes that were being most commonly used so at least our practitioners knew what was coming in regards to specificity.”

Mark Crandall

The ongoing preparation and training at Consulate, as well as the ultimate goal of getting the truest story about the diagnosis of the patient, unquestionably helped the organization be well-equipped for whatever was thrown its way in October, Crandall attests. “Sure, we had some technology hiccups in the first few days. But that was quickly remediated by one of our vendors. We weren’t really shocked by anything,” he says. There are good things and bad things about technology—it’s not always fastest pathway to best patient care,” Crandall adds. “If you heard of the functionalities out there, there is the 1:1 [ratio] built by our software vendors to ease the process for coders. But we found in our testing that it doesn’t always choose the best ICD-10 diagnosis code for the patient. We wanted to take advantage of the coding changes—not the technology changes—for what tells the truest story of the patient. And that takes training. For us, with the largest part of our portfolio being in Medicare and Medicaid buckets, it’s been important for us to get out ahead of these changes and always try to be part of pilot programs,” he says.  

Similarly, for other organizations, the sky didn’t fall when the calendar hit October. At Boston-based Partners HealthCare, the biggest concern leading into the transition was that everyone was mapping what they were doing in the ICD-9 world to try to get equivalent comparisons in ICD-10, says Paul Dufresne, patient account manager at Partners. “That was the approach that people chose. But that can be subjective, and it could lead to missed diagnoses,” Dufresne says. However, he adds, these mapping issues were not nearly as bad as Partners anticipated. “We were expecting big-time disasters, and it wasn’t like that at all.”

Similarly in the Northeast, at the Newton, Mass.-based Atrius Health, ICD-10 didn’t prove disastrous either, says Michael Lee, M.D., director of clinical informatics. Atrius started its ICD-10 work in 2012 and was thus ready in 2014, at which point the government delayed the transition for a third time. But the planning that went on during that three-year-long undertaking proved beneficial when the deadline finally came, Dr. Lee says.  “We spent a ton of time on mapping tables, getting diagnoses files correct, and the majority of time after that was on the revenue side testing transactions coming out of our systems, then testing those transactions arriving at our insurer systems, and then testing responses. We had that back end pathway worked out so we could get paid,” Lee says. “We were working on this for a long time so we were comfortable that we would be reasonably okay with the conversion.”

Michael Lee, M.D.