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During the past 18 months or so, I have talked with many hospital CIOs and HIM professionals. I’ve been impressed with how so many organizations have accepted the transition to ICD-10, and have had plans to do so in place for some time.
My impression is that hospitals are moving right along toward meeting the transition’s October 2013 deadline. And according to the surveys I’ve read, most feel they will make it. But now, CMS may move that deadline out, which has the potential to severely complicate training and implementation cycles. There was a lot of buzz about a delay at HIMSS last week, and that is the topic of my blog.
This year, HIMSS occurred almost concurrently with the comment by CMS acting administrator Marilyn Tavenner indicating the implementation of ICD-10 may be delayed. The announcement of an ICD-10 delay was greeted by different people with wildly different reactions. Here are a few of their comments:
1. “Thank goodness,” said a CFO. This was the refrain of almost everyone currently in the active roll-out process of some other healthcare IT initiative that is massive. Many have done some preliminary assessment and project planning for ICD-10, but knew they were only 5 percent into a massive training, building, analysis and roll-out by the current October 2013 deadline.
2. “A delay will seriously damage my credibility within my organization, from the C-suite on down.” This was the lament of many CIOs who had done their homework, developed solid plans through a painstaking process, and most importantly, educated their executives that the current deadline was firm. All indicators suggested the government would stand firm on the 2013 date. Now we learn CMS is uncertain about its commitment.
3. “This was inevitable and the sober thing to do,” a physician told me. The thinking here goes along the lines that it's too great of a burden on the doctors and the improvement in data quality is of negligible consequence to patients or doctors. The true intent of those promoting the transition is to further reduce reimbursement to providers for care. Note this is contrary to the position AHIMA has steadfastly professed for many years.
4. “Moving the date introduces significant new logistical challenges.” That came from a hospital HIM director. When there was a specific switch over date, the logistics of getting ready and meeting a fixed deadline were clear and manageable. It's been done in other countries, in fact, most other countries – long ago. If we move the date to a window of time during which dual systems are allowable, we will have to use systems that weren't designed for dual use. This will introduce new workflow requirements and complicate enforcement.
I expected reaction number one. The other three I understand, but speak to issues that won’t be fixed by simply moving the date.
Is the fact that SNOMED is the only code set now allowed for problem lists in the Notice for Proposed Rulemaking for MU Stage 2 a precursor for delaying the deployment of ICD-10? Does a delay indicate that CMS places more importance on the lobbying by groups whose members have, for a number of reasons, not implemented a plan for the transition to ICD-10, as compared to the tens, perhaps hundreds of millions of dollars invested by vendors and healthcare providers determined to meet the existing deadline?
Healthcare providers face multiple deadlines to implement new systems and methodologies designed to improve quality of care, patient safety, and streamline reimbursement. The deadlines for implementing EDI 5010 and MU Stage 1 have already been pushed out. Is it proper to do the same for ICD-10, knowing that in 2009 the deadline was changed from 2011 to 2013, and considering the development of ICD-10 was completed in 1992, with about 110 other nations already using the system?
What do you think?
Joe Bormel
CMO and Vice President
QuadraMed Corporation
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"Indecision is like a stepchild: if he does not wash his hands, he is called dirty, if he does, he is wasting water." ---- African Proverb