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Are We at an ICD-10 Inflection Point?

November 22, 2011
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Time is clearly of the essence now in preparing for the transition

There’s much to say about the process of transitioning from the ICD-9 coding system to the ICD-10 system, a process mandated by the federal government to take place by Oct. 1, 2013, which is why we are presenting an ICD-10-themed newsletter this week.

Now, here’s something that is “very healthcare”: as with virtually every other broad federal mandate, there emerges a natural bell curve of patient care organizations, with some providers moving forward boldly to get ahead of the curve on any particular mandate, others positioning themselves not far behind, and then a whole lot of organizations hanging back and waiting until the last minute to do what’s necessary. The challenge with mandates like that around the ICD-10 transition is that these involve initiatives that can’t be done in a day, or even in a few months.

In that regard, it’s rather shocking to learn that, as our Assistant Editor Gabriel Perna reports in his web-exclusive report, “As the ICD-10 Clock Ticks Down, Providers Face a Lengthy Road Ahead,” only 9 percent of provider organizations were more than halfway through their ICD-10- transition process, as of October, according to a report recently released by the KLAS folks. KLAS also found that a significant plurality of patient care organizations hadn’t yet even set a full ICD-10 implementation budget.

Here’s the reality: as we interview healthcare IT leaders nationwide, we’re finding two things. First, those patient care organizations that tend to make headway in one strategic area tend to make headway in others (see my interview with UPMC health system CMIO G. Daniel Martich, M.D. on his organization's transition). So, not surprisingly, those that are farther ahead on meaningful use attestation also tend to be ahead on the development of accountable care organization-type contracting; and also tend to be farther ahead in preparing for the ICD-10 transition. Second, those organizations whose leaders have been most aggressive in pushing them forward, are the ones giving themselves the time needed to do it right, and furthermore, to be able to most optimally leverage their IT development to improve patient safety, care quality, clinician workflow optimization, cost-effectiveness, accountability, and so on.

Naturally, moving forward on the ICD-10 transition is a difficult thing, and is made all that much more challenging by the fact that providers are having to move forward on the gigantic meaningful use process at the same time, as well as on three mandatory healthcare reform-driven programs, and potentially on two voluntary programs. Not surprisingly, all this amounts to a gigantic to-do list, and CIOs, CMIOs, and other leading informaticists are on the hot seat for producing results—pretty darned quickly, in fact—in all these areas.

So it’s not really surprising that, earlier this month, the AMA petitioned the federal government for a delay in the ICD-10 implementation deadline, as AMA leaders met for their semi-annual policy-making session. “I think this is indicative of the level of frustration from the regulatory and financial pressures that physician offices and practices are feeling today,” AMA Board Chair Robert Wah, M.D., told our Associate Editor Jennifer Prestigiacomo (see “Industry Associations Debate Whether to Delay ICD-10,” also in this newsletter issue) recently. But, viewed from a broader perspective, will it really help physicians to postpone the ICD-10 deadline by months or maybe a year?

The deeper reality is that the healthcare system is at rather a key inflection point right now, and the ICD-10 transition is one element in that broader scenario. And the leaders of the pioneering patient care organizations in our industry know this, and are moving forward resolutely to do what they know the purchasers and payers of healthcare want: to create a more transparent and accountable healthcare system, one with continuously self-improving patient safety, care quality, cost-effectiveness, and efficiency.

As if all these federal mandates weren’t enough to underscore what purchasers and payers are demanding, anyone who was paying attention this week noticed that the so-called super-committee in the U.S. Congress, charged with working out a package of federal budget cuts, was unable to do so, with the result that significant provider pay cuts under Medicare in 2013 are virtually assured. Now, political experts are saying that, following the 2012 elections, it’s possible that something might be worked out during the 2012 lame-duck session.




Thanks for the interesting post. I have had the privilege of participating in the review of the ICD-9 to 10 audit process. There are two pieces worth calling out. One is identifying how many ICD-9 codes now in use at a provider would need to be coded more specifically in I-10. Without doing this, it's impossible for a provider to get more than a swag of an estimate of the transition work and costs.

Second is the related clinical documentation improvement (CDI) opportunity. It's a different situation if the existing documentation supports coding in ICD-10, or if it isn't adequately detailed. For example, ICD-10 enables a coder to specify if a stroke is right sided and what artery is effected. If the clinicians are documenting this clearly today, say 95% of the time, the change in physician behavior required is much less than if their documentation is weaker.

Documentation quality is a pre-condition necessary for improvements in quality, costs, and access. Coding in ICD-10 may not be the primary challenge. The AMA's focus on regulatory and financial pressures may be misplaced, if the solution requires draining the swamp.