As most readers are aware, on March 31, 2014, the Senate passed a bill that delayed ICD-10 enforcement, which was originally slated to be implemented Oct. 1, 2014. The delay was achieved through a paragraph in a bill that focused on postponing cuts in Medicare reimbursement to doctors that would otherwise be required under the Sustainable Growth Rate formula. The one year delay in ICD-10 implementation was cause for celebration by some, but also angered and frustrated many in the healthcare industry.
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From the perspective of physicians reading this blog, I suspect there is much relief. Based on conversations I have had with providers and group practices, most seem nowhere near ready for the switch to ICD-10, no matter how many years it has been approaching. This is hardly a surprise. With the myriad of regulatory and technological changes providers have faced in recent years, whether HIPAA enforcement or the introduction of EHR systems, it’s a wonder doctors have much time and energy to practice medicine at all.
There is no doubt that the cost of switching to ICD-10 is an expensive proposition, with the AMA estimating the expense at as much as $8 million for a large physician practice and more than $225,000 for a smaller one. Even among those that may have upgraded in expectation of complying with ICD-10, many have yet to prepare for the change to ICD-10. At a recent physician lecture I attended, which covered the basics of the ICD-10 transition, physicians seemed amazed at the specificity required for claims to be processed (i.e. the burn occurred in the kitchen while cooking) and alarmed at the overwhelming number of codes they would be required to navigate. With thousands of very specific codes to consider, ICD-10 undoubtedly presents a challenge, particularly for those who run small operations or perhaps even handle their own billing. For some, ICD-10 may perhaps become the final, insurmountable hurdle for their independent practice.
An additional concern for many practices is how ICD-10 will impact productivity and reimbursement. Doctors are already buried in clinical and administrative/regulatory demands, which impact their available time with patients. Now, the time required to properly bill for services using ICD-10 could burden physicians further. An additional (and realistic concern) is how physicians will be impacted if incorrect data is entered as physicians learn to use ICD-10. The financial harm that might be caused by delays (as a result of rejected claims) is real. Unlike hospitals and health systems, solo physicians and many small and medium physician groups may lack the manpower, sophistication, and funds to devote to the ICD-10 switch and training. No matter how much time there may have been (and may remain) to prepare for ICD-10, these are very real concerns for practicing physicians.
It’s no surprise that hospitals and the healthcare IT community are fighting against the delay. Most are ready for the transition, having installed new systems, trained staff, and made other necessary changes. They have spent an enormous amount of time and money preparing for this change and the delay is frustrating and unfair. What about the thousands of coders who have been trained in ICD-10 exclusively in expectation of the October switch? What will be happen to them now and how will this impact the healthcare industry? There is no acceptable answer for the thousands of institutions and providers who have embraced ICD-10 and who find another delay intolerable.
Though there are different sides to this argument, there can be no dispute as to the value that ICD-10 will bring. How else can we obtain higher quality metrics, more accurate public health tracking, and better data on how care is delivered across this country? Is there a way organizations that are ready can start submitting data in ICD-10 format? Can we avoid the change being mandatory and, instead, create a more gradual switch to ICD-10? What else can be done to help physicians prepare for and embrace ICD-10 if they lack the funds and support to be able to transition?
There are many ideas and issues that are likely to be debated in the weeks ahead concerning the ICD-10 delay - how do you feel about the delay in implementation?