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The Negative Side Effects of the ICD-10 Delay on Physician Practices


A medical practice director who worked hard to prepare for ICD-10 implementation says the delay comes at a heavy cost.

When Congress issued another short-term patch to Medicare's flawed Sustainable Growth Rate formula in late March, and along with it an unexpected delay to the implementation of the ICD-10 coding set, many physicians and administrators breathed a sigh of relief.

But the delay left many other others, like Cathryn McQuaig-Smith, practice director of a three-physician ophthalmology practice in Milledgeville, Ga., disheartened and frustrated.

" ... For the administrator of CMS to say emphatically more than once, 'This is not going to get delayed,' and then for it to get delayed, I think physicians are really getting disgruntled and we just are so jerked around." Cathryn McQuaig-Smith, practice director

"Honestly my response was a little bit angry," McQuaig-Smith told Physicians Practice. "I felt like we were in the minority, those of us that were kind of angry ... How many times did [CMS Administrator] Marilyn Tavenner say 'This will not be delayed?' 'This program will not be delayed?'"

In fact, Tavenner did voice this warning numerous times, including most recently at the Health Information Management Systems Society annual conference in February.

At press time, CMS had not yet commented publicly on the delay (which came about as a result of congressional action; it was not set forth by CMS) and/or the future of ICD-10. 

"What other industry is jerked around like this?" said McQuaig-Smith. " ... For the administrator of CMS to say emphatically more than once, 'This is not going to get delayed,' and then for it to get delayed, I think physicians are really getting disgruntled and we just are so jerked around."

McQuaig-Smith, who took CMS' repeated reassurance seriously, spent time ensuring that her staff, her systems, and her physicians would be prepared for the transition. She invested in ICD-10-related webinars, books, and software; and she and her staff attended meetings, conferences, and worked to update their systems.

Some practice administrators McQuaig-Smith knows took even broader measures. One hired two new coders and sent them to several ICD-10 training sessions; and another dedicated a weekly time slot to ICD-10 discussion and training.

"... The big thing is the time," said McQuaig-Smith. "We spent an egregious amount of time [preparing]."

But lost time is not the only factor leaving McQuaig-Smith reeling. The delay is also taking a toll on staff morale, she said. "You spend several days converting your whole charge slip to ICD-10, you spend all this time preparing everybody to convert the system, and you coordinate training and all that kind of thing, and you tell everybody, 'This is going to happen,'" she said. "Then, as the administrator, you have to come and say, 'Well, never mind.'" 

McQuaig-Smith is also frustrated because her practice held back in other areas, such as the EHR incentive program, so that it could focus on meeting the ICD-10 implementation deadline. 

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"... You've got meaningful use, you've got PQRS, you've got the value-based modifier coming next year, you've got the Affordable Care Act requirements, and now you have ICD-10," she said.  "Not all practices have the resources to do it all, and so we said, 'We're going to do PQRS and avoid that fee-schedule cut, prepare for the value-based modifier, [and] we'll be ready for ICD-10.' We made those decisions based on the fact that we felt ICD-10 implementation was coming this year, and so when it didn't, I was a little disgusted."

Despite her frustrations, McQuaig-Smith said she plans to continue moving forward with ICD-10 preparations at her practice, only with less urgency than before.

"I guess this will give us more time to get the staff and more importantly, the physicians, better trained ..." she said. "What can you do? It's been very demoralizing the last 12 months ... It's just demoralizing to have to go in and constantly tell staff, 'Things have changed, do it this way,' 'Do it that way,' and, 'By the way we're not going to do this anymore.'"

Do you relate to McQuaig-Smith in that you did not greet the ICD-10 delay with open arms? What drawbacks are you experiencing? Share your thoughts in the comments section below.

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