ICD-10 will hit home in 2013


A year ago, industry chatter centered on whether there would be a delay to ICD-10. We saw many healthcare organizations at risk for not meeting the original October 2013 deadline, while others were well positioned for a successful, on-time transition.

What a difference a year makes…or does it? The deadline is moved back 12 months to October 2014, but we still hear some of the same questions and see some of the same challenges. But overall, we’re seeing more healthcare organizations actively working on ICD-10.

Next year — 2013 — is when ICD-10 is going to take on an increased urgency for everyone. Here at Edifecs, where we provide software that streamlines the exchange of health information, we’re already seeing a change in the conversations we’re having with our customers and prospects. Based on those discussions and what we’ve learned about government mandates over the last several years, we've come up with the following three key predictions for 2013.

It’s a date
In early 2012, the U.S. Department of Health & Human Services (HHS) announced it would consider delaying the ICD-10 implementation deadline to allow more time for the transition. Industry reaction was swift and overwhelmingly against a lengthy delay. Edifecs’ own survey of healthcare professionals attending the ICD-10 Summit showed that nearly 70 percent of respondents believed a two-year delay would be either “potentially catastrophic” or “unrecoverable.”

As we all know, HHS decided to impose only a one-year delay, but as the original 2013 approaches, many are asking, “Will HHS will do it again?” The short answer is no. 

Given the amount of work that’s already underway across all segments of healthcare (and the corresponding dollars that have already been spent), we don’t believe HHS will risk the potential backlash from a second delay. Especially since it could mean the death of ICD-10. Healthcare executives we’ve talked to have already said they won’t be pleased. Their likely reaction? Something along the lines of, “Another delay? Fine -- I’m stopping all efforts and shifting resources to other mandates where I really do have a date I can trust. Let me know when you’re serious about ICD-10, and then I will be, too.”

The domino effect
One thing that’s different about ICD-10 compared to other mandates is the level of collaboration required among payers, providers and the third parties who help them manage and exchange both clinical and administrative transactions. External testing will be a critical component of successful ICD-10 transition and it will become a much larger priority for payers in 2013, especially as summer approaches that year. The problem is that most providers won’t be ready to test until sometime in 2014, creating a logjam of providers wanting to test as we get closer to the deadline.

While some forward-thinking providers are likely to at least perform some manual comparisons and testing, their systems won’t be ready to handle full testing until much later—probably the summer of 2014. At that point, we’ll see hundreds of thousands of providers all clamoring for collaborative testing with payers, and the resulting logjam and disruption will be something the industry hasn’t encountered before.

Show me the money, or…not
Next year will challenge providers like never before, particularly in HIM departments. Considering all the competing initiatives and mandates such as meaningful use and CDI initiatives, providers will have a hard time allocating resources to ICD-10 testing. Clinician and coder productivity is likely to take a hit—especially among providers who decide to dual code their charts prior to transition. While that may seem like a good idea in the short term, it will cause documentation delays, leading to final bill delays, which will lead to payment delays and — eventually — cash flow issues for providers.

The alternative isn’t pretty, either. If providers cut back on dual coding to improve cash flow, they may not be adequately prepared for ICD-10 and will encounter even more cash flow delays after the transition.

Of course, it doesn’t have to be all gloom and doom. If they haven’t already, payers and providers need to start looking at existing plans, budgets and resources from the standpoint of what contingencies they need to have in place. And ICD-10 is very much a collaborative effort, so healthcare organizations should be talking to all of their trading partners and vendors to ensure they’re doing the same. In this case, the Boy Scout motto of “Be Prepared” is good advice indeed.

Ryan McDermitt is senior director of product management at Edifecs.