ICD-10? Headache or Miracle? You Decide

A train wreck? Or the healthcare industry’s best shot at improving the way it “describes, bills and pays for services?”

According to a story by Gary Baldwin, industry feelings about switching over by October 2013 to the new coding for classifying diseases for reimbursement, ICD-10, is making many, many healthcare providers break out in a cold sweat.

Most fear payments will stall or worse, never materialize, due to the complexity of changing from the old coding, ICD-9, to the new one. But others see “a new era of improved documentation, quality and outcomes,” Baldwin writes. And some are even just pleading for more time.

Baldwin says the top 10 “fear factors” providers have are industry preparation, vendor readiness, “shadow” systems (where other departments may have created databases separate from what IT controls), productivity hits, dual processing, testing, “undermined analytics,” transition expense, and trading partner readiness. 

ICD-10, as did ICD-9, will become the backbone of clinical documentation and billing, according to Baldwin, who interviewed Jim Daley, co-chair of the ICD-10 workgroup at WEDI, a member organization that promotes electronic data exchange and standards. Baldwin says that Daley has one overarching concern about the transition to the new coding system-industry readiness. “Organizations are aware of ICD-10, but the problem is allocating resources to it,” says Daley, who is also director of IS risk and compliance at BlueCross BlueShield of South Carolina, Columbia.

Carl Natale has a very dark outlook for the switch. “Billions will be spent, many healthcare IT projects will be deferred for the next 2 years, and the end result will be no cost savings (coding costs are likely to increase 50 percent), no quality improvement, no increased safety, and no efficiency gains,” he blogs.  “If we complete the ICD-10 project on time, no one will notice, but customers will all be angry at the IT department (and the CIO) for the work on other projects that was deferred It's one of those all risk, no reward situations. Healthcare providers need to make this work just to keep the reimbursements that they have.”

Half of the 600 payers and providers surveyed earlier this year by TEKSystems, an IT staffing firm, say that ICD-10 “has much broader impact than they expected,” Baldwin writes. Sixty percent said their project plan was still in development, he reports, compared with only 22 percent who are done. The rest either were still at the starting gate or did not know when the switch would be completed.

And think about this. The number of diagnosis codes will expand from 13,000 to 68,000, with procedure codes ballooning. A lot for anyone to handle.

What about the people using the coding? Worries abound that a steep drop in work output will occur. And physicians, too, will be called on to perhaps document with even greater specificity than they do now, Baldwin writes.

What worries everyone the most? Disruption of cash flow. Providers need to be preparing now for it, Dan Fagin, managing director of Protiviti, a Cincinnati-based health care IT and business consultancy, told Gardner. “The productivity dip that is all but guaranteed to hit physicians and coders will have an initial negative impact,” he said. “It could take longer to get claims out the door. . .There could be a spike in denials. Providers should model different cash flow and AR day scenarios.”