ICD-10: What's Next?

Edited by Ken Congdon, Editor In Chief, Health IT Outcomes

The ICD-10 compliance deadline may have been extended by one year, but it shouldn’t be viewed as an opportunity to procrastinate. Here’s how you should use the extra time to ensure success.

As we all know, HHS has proposed a rule that will extend the ICD-10 compliance deadline by one year from Oct. 1, 2013 to Oct. 2, 2014. Currently, U.S. doctors and hospitals use the ICD-9 code set, which includes 13,000 diagnosis codes and 11,000 inpatient procedure codes. With ICD-10, the number explodes to 68,000 diagnosis codes and 87,000 inpatient procedure codes. The new codes provide greater clinical detail and cover medical treatments and technologies not reflected in ICD-9. The transition from ICD-9 to ICD-10 is a massive administrative and financial undertaking for hospitals and physicians. So much so, the AMA (American Medical Association) led the movement to push off the ICD-10 implementation deadline, citing concerns about the ability of physician practices to comply by Oct. 1, 2013. Now that an extension has been granted, it’s important for both hospitals and practices to use this time wisely to adequately prepare for the transition to ICD-10. In this Q&A, Fletcher Lance, national healthcare leader at North Highland, a consulting firm with experience driving ICD-10 and Meaningful Use initiatives for several health systems, hospitals, and hospital management companies, provides his advice on how to move forward with your ICD-10 initiative.

Q: What impact will the ICD-10 delay have on healthcare providers?

Lance: I feel the delay benefits smaller providers. Physician practices with eight doctors or fewer faced a significant challenge trying to meet ICD-10 and Meaningful Use, all while having to see 25 to 30 patients a day.

At the same time, I feel the delay is a missed opportunity for hospitals and health systems, because many of these organizations had already allocated the funds and were forming implementation teams for the ICD-10 transition prior to the extension. I feel the delay will unnecessarily elongate the process for these facilities. My hope is that the delay will give all providers more time to plan and will ultimately improve ICD-10 execution.

Q: How would you advise healthcare providers to proceed with ICD-10 with the delay in mind?

Lance: If you were ready to move forward with your ICD-10 transition before the delay, don’t stop your progress now. Take the extra time to plan and firm up your coding resources. Consider the impact the ICD-10 transition could have on other IT systems, and ensure your HIPAA 5010 efforts are shored up.

The best advice I can give to providers is not to get overwhelmed by the 68,000 or 87,000 new codes. Instead, simplify your plan. Identify the top 150-300 codes that really “move the needle” for your facility, and focus on getting really good at those first. Once those are perfected, you can incrementally add others.

Q: What are some of the key health IT applications that will be impacted by ICD-10?

Lance: Most people focus their attention on HIM because they believe this is the only system that will be impacted by ICD-10. HIM definitely bears the brunt of the impact, but other systems are also affected. In fact, in a recent ICD-10 assessment we performed for a large health system, we identified 30 subsystems that would be impacted by the transition. These subsystems included everything from EHR and e-prescription applications to patient registration systems.

This realization will surprise a lot of people. My advice would be to look at where all data is housed prior to an ICD-10 transition. Even systems where data is housed, but not regularly used, are worth checking.

“There is going to be a definite rush for health IT and coding resources ... due to ICD-10 and Meaningful Use. Those that sit on their laurels or wait too long to initiate their ICD-10 transition could have a hard time finding the resources they need.”

Q: Are there any ICD-10 best practices you would recommend?

Lance: Physicians are probably going to struggle during the ICD-10 transition. It’s important to provide them with adequate training to get them ready. Coding training and resources will also be in demand. One best practice I would suggest is to begin establishing partnerships with organizations such as AHIMA (American Health Information Management Association) today. Don’t wait. It’s likely that you will need to contract out coding and training responsibilities during your transition. You want to ensure that you have a reputable partner who can help provide you with all those resources when the time comes. You don’t want to be forced to hire all of those people.

Q: What are some of the risks if providers use the ICD-10 delay as an opportunity to procrastinate?

Lance: As mentioned, there is going to be a definite rush for health IT and coding resources over the next two years due to ICD-10 and Meaningful Use. Those that sit on their laurels or wait too long to initiate their ICD-10 transition could have a hard time finding the resources that they need.

Q: Are there any risks associated with moving too quickly on an ICD-10 transition?

Lance: There could be. There’s always a chance that the deadline could get pushed back again, and healthcare facilities will find that they’ve allocated tons of financial capital and human resources into ICD-10 that they could have used to accelerate their Meaningful Use initiatives. Healthcare facilities need to make sure they balance these priorities appropriately.

Q: What are some potential ICD-10 transition mistakes that you would caution healthcare providers to avoid?

Lance: We’ve already touched on some of the likely mistakes. As mentioned, a “wait-and-see” approach is not a good strategy because of the demand for resources. A “Hail Mary” approach is also likely to be ineffective because there are too many moving pieces and too much process change required organizationally. You need to think about ICD-10 in a systematic way. What will remediation look like? What will the impact of ICD-10 be on the organization? How will reporting change? And ultimately, what will the potential benefits of ICD-10 be?

Q: How will ICD-10 change healthcare?
Lance: My hopes are that the specificity of the ICD-10 codes will lead to better patient outcomes. Furthermore, I feel ICD-10 will help improve the quality of data reporting on those outcomes in a manner that will drive patient-centered care. In other words, predictive models could be generated for each patient based on their ICD-10 codes and other health data. This data would allow them to select the best provider at the lowest cost for their specific health profile. ICD- 10 could bring a new layer of “consumerism” to the healthcare industry.