Trends to watch in 2013

We've established that I'm not very good at predicting how ICD-10 preparation will develop. But there are some things I will track in 2013 that could affect the state of ICD-10 preparedness:

Deadline pressure
The American Medical Association remains vigorously opposed to ICD-10 implementation and promises to investigate whether the ICD-11 code set could be implemented instead. I'm not sure this will have much effect on the Oct. 1, 2014, deadline.

I'm more worried about testing. Major hospitals, healthcare payers and trade groups will start testing ICD-10 systems. While the tests may not be perfect, they should expose any major vulnerabilities this. And that could give the Centers for Medicare & Medicaid Services something to think about.

Remember last year's problems with the HIPAA 5010 transition. Another delay might be called for.

I said "might." I don't think another delay is likely. But everyone needs to be aggressively testing and watching for weaknesses. Chances are the problems can be solved and disruption minimized.

The budget battle
Mention the fiscal cliff and my eyes glaze over. (And what's the ICD-10 code for that?) But I woke up when I heard that one of the elements negotiated in the New Year's Eve agreement is a one-year delay of a nearly 27 percent cut in Medicare payments to healthcare providers. Basically, anything was up for negotiation as senators, representatives and administration officials tried to gain enough support for a deal.

So far it doesn't look like the ICD-10 deadline got thrown over the fiscal cliff to get a deal done. But in Washington, anything and everything is open for debate.

Disruptive innovation
I'm going to keep an eye out for innovations that simplify the business of healthcare for less money. The computer assisted coding systems being pitched by major HIT vendors are wonderful. But they're pricey. And that's what really has physicians vigorously opposed.

They see ICD-10 implementation as a battle between simple physicians who just want to practice medicine vs. the big healthcare vendors.  They don't want to have to spend a lot of money and time supporting ICD-10 codes.

That is an opportunity for someone to sell simple, inexpensive solutions. A major vendor may not consider the quality to be comparable. But it's the physician writing the checks who will be the final judge.

This is the year that clinicians need to learn more about ICD-10 codes and improved documentation. Also, major healthcare providers will be training medical coders to use the ICD-10-CM/PCS code sets. And trainers need to be trained to teach ICD-10 coding.

It's worth watching to see if we're going to have enough ICD-10 expertise in place. While most ICD-10 knowledge only will be used in testing scenarios and coding practice, having those skills available will be valuable to ICD-10 transition teams. This will have a significant impact on how the transition progresses in 2014.

The year of getting it done
I see 2014 as a year of major steps taken toward implementation. The bigger organizations should have all their systems in place to use ID-10 codes. It should be a matter of testing and practice for them.

I doubt everything will be perfect. Expect some major learnings and takeaways to come out. Then the smaller procrastinators could benefit from that experience and have a smoother ICD-10 transition.

Carl Natale blogs regularly at