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Moving Forward on ICD-10

November 5, 2010
by Mark Hagland
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Interview: Tony Trenkle, Director of the Office of E-Health Standards and Services, CMS

As the deadline approaches for healthcare organizations to make the transition to the ICD-10 coding system from the current ICD-9 system for federal reimbursement, many providers remain challenged by a thicket of practical and logistical issues. Recently, Tony Trenkle, director of the Office of E-Health Standards and Services (OESS) at the federal Centers for Medicare and Medicaid Services (CMS), spoke with HCI Editor-in-Chief Mark Hagland regarding the challenges providers are facing, and his office’s work in support of their transition. He also discussed the coming transition to the Version 5010 standard for some electronic health transactions. For more information readers can review the Jan. 15, 2009 news release on the CMS Web site.

And they can read more about the ICD-10 transition on CMS’ outreach Web site on the subject

Healthcare Informatics: The looming deadline of October 2013 remains rather daunting to providers. What’s your sense of how quickly and effectively patient care organizations are moving forward to prepare for the ICD-10 transition?

Tony Trenkle: I do acknowledge that there are a lot of different mandates out there, and there are a lot of key initiatives that have begun since the initial ICD-10 regulation came into place a few years ago. A number of organizations are moving forward rather quickly to implement ICD-10; others are lagging behind. We work rather closely with provider associations and health plan associations, not only to measure where everybody’s at, but also to look at ways we can assist different provider groups or other entities to move forward.

HCI: There has been some buzz in the industry about the deadline. Is there any chance the deadline could be moved in any way?

Trenkle: Well, I’m not planning to move it at all, so unless legislation were passed, or through a statute change, that won’t happen. The deadline remains Oct. 1, 2013; and the Affordable Care Act [the federal healthcare reform legislation passed in March 2010, the Patient Protection and Affordable Care Act] also includes several references to ICD-10, because they recognize that the ICD codes are very much integrated into the business processes in healthcare today, so if you add additional granularity, it will, for example, allow providers to code more accurately, which should assist in getting claims paid more quickly and create less of a problem in terms of understanding what the diagnosis is. And there are certainly elements of granularity in ICD-10 that will assist in terms of quality evaluation as well. So while there may be talk of date changes, the code set change is long overdue, and it’s critical to make that change to help support the Accountable Care Act. In addition, I would add that the transition very much enjoys bipartisan support; the final publication of the regulation took place on Jan. 16, 2009, about a week before the inauguration of President Obama.

HCI: What are people most struggling with, from what you’re hearing?

Trenkle: One, as I said, is the fact that this is one of several important initiatives right now; a second is the need for training and preparation; and the third is that there’s a lack of understanding of when the transition actually is. So we’ve been involved in outreach efforts. One of those efforts involves, our outreach site. If you go out to it, one of the things you’ll see is that we do several things with this Web site, we’ve divided it up into several sections, including provider resources, payer resources, and vendor resources. And we’ve tried to link that site with those of the various stakeholder associations, so we can have a two-way communication with them; we also now have a listserv that you can register for right on the Web site, and we’ve got over 11,000 subscribers to that. The listserv sends out weekly updates for any information on the Web site or messaging. We haven’t yet set up any types of discussions on there, though that might be a possibility. But we’ve also engaged all 10 regions of CMS with an ICD-10 lead, who gets out to the local medical societies and other key stakeholders in their regions. For example, each region of CMS has a chief medical officer, who goes out and meets with physicians. We’re also meeting with various stakeholder groups.

HCI: Does that include hospital and health system CIOs and other healthcare IT leaders?

Trenkle: We work with the [Washington- and Chicago-based] American Hospital Association, and work very closely with HIMSS [the Chicago-based Healthcare Information and Management Systems Society], and in fact are working with HIMSS to sponsor one of their educational sessions at HIMSS 2011; we’ll have an entire day devoted to ICD-10 and 5010. We actually have a very comprehensive outreach effort going on. The outreach is also coupled with environmental scans, so we are focusing not only on sending messaging out, but also verifying its effectiveness.

HCI: At this point in time, are you optimistic about the transition?

Trenkle: Well, ‘optimistic’ isn’t really the right word; it’s about diligence and preparation. Optimism comes out of preparation. And we’re trying to target all the stakeholder groups for preparation. And if we do our preparation right, this will go well. We recognize that this is a very major effort; it’s not a trivial undertaking, we recognize that.

HCI: Can you talk about the core changes with the transition to the 5010 standard?

Trenkle: Basically, there are a number of transaction sets that when the original HIPAA standards were adopted, are now being updated to reflect some inconsistencies and problems in the original set of standards years ago. That’s basically what 5010 does. When you put out a standard, you never have a perfect standard, because as soon as a standard is out there, people begin to see problems. So over the years, people have recognized problems in 4010 that are being changed in 5010. But one of the changes will be allowing for enlarging the field sizes that will be required under ICD-10. 5010 is really a straight software upgrade issue. And though it’s needed to get to ICD-10, a lot of the work around 5010 will be done at the vendor level.

HCI: Do you have any advice to offer to hospital and health system CIOs?

Trenkle: Yes, the main advice is that if you haven’t started on it, you need to begin planning the transition as soon as possible, and to begin working actively with your vendors. And that’s pretty much the basic message we’ve had for all providers.

HCI: Do you have anything else to add?

Trenkle: The basic message is that we think ICD-10 is critical to a number of key improvements we’re trying to make to the healthcare system; it’s a very major undertaking that providers need to move forward to prepare for as soon as possible; and we have a wealth of informational resources to offer to them. And one of the things we have on our Web site—as a covered entity, CMS has had to do a major analysis of our own business processes, so we’ve actually got the impact analysis and other documents on our Web site; and we actually have 18 workgroups within CMS working on various aspects of the transition. The thing you’ll see is that we’re not just looking to do a cut-over, but we also asked our contractor what some of the advantages we might be able to obtain through the transition, in terms of fraud prevention, research, quality measures, and other areas. And that’s one of the things we’re asking our workgroups to focus on as well, and there’s information on the Web site under the section called CMS Implementation Planning.


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