Public and private sector health care leaders roll with ICD-10 delay

CMS calls for state Medicaid IT leaders to share their ICD-10 implementation difficulties; AHIMA responds to ICD-10 delay.

CMS finalized its rule for a one-year ICD-10 delay proposed earlier this year, thus officially moving back the switchover to Oct. 1, 2014. HIT leaders reacted favorably in general, though they acknowledged that many health care providers have already invested in the switchover from ICD-9, and that one year is enough.

Melanie Endicott, director of HIM Solutions for the American Health Information Management Association (AHIMA), told SearchHealthIT the coders' group -- which had lobbied against the ICD-10 delay -- is at peace with it, and hopes the additional time will help get its members and health care providers up to speed on ICD-10 physician education and IT systems implementation.

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"We didn't want a delay at all because our members -- for the most part -- are on board; they're ready for 2013 and they've invested a lot of time and money into it," Endicott said. "With the delay, that increases the costs to keep their coders and everybody else within the organization trained and ready. But we are happy that it's only one year. We were worried it would be more than that."

Endicott also said that although Centers for Medicare and Medicaid Services (CMS) hasn't yet formally announced an ICD-10 testing program along the lines of its HIPAA 5010 transaction testing earlier this year, the idea has been discussed. If the agency were to use the extra year to set up a provider-to-CMS testing mechanism, she feels it will help alleviate some angst between CMS and the health care system -- and perhaps reveal technical glitches that can be corrected before U.S. health care "flips the switch" on ICD-10 for real.

The College of Healthcare Information Management Executives (CHIME) officially took the glass-half-full approach to the announcement, too. That's in contrast to some individual hospital CIOs for larger health care providers who have told SearchHealthIT.com that it's hard to get chief executives and finance departments excited about IT investment in ICD-10 implementation when groups like the American Medical Association and others decry the coding language; CMS hears it and then institutes delays. Yet ICD-10 and its bundle of technical implications still are coming, whether the CFO broadens the IT budget to support it or not.

“CHIME is pleased that CMS understood the importance of finalizing its proposed one-year delay for compliance to ICD-10,” said CHIME CEO Richard Correll in a statement emailed to the HIT media. “In public comments filed last April, CHIME urged CMS to keep its proposed one-year delay because a longer delay would seriously disrupt ongoing efforts to convert to ICD-10. And, as HHS itself recognizes, a longer delay would significantly increase the costs of converting to ICD-10."

State Medicaid IT leaders discuss ICD-10 issues

In the days before the ICD-10 delay was announced, federal and state Medicaid IT leaders met in Boston for the Medicaid Enterprise Systems conference. A group of state Medicaid attendees broke off into a meeting to catalog their ICD-10 implementation problems at the behest of federal officials, who hoped to better understand -- and, ostensibly aid -- the states in ICD-10 preparedness.

Some state IT leaders said ICD-10 wasn't necessarily an IT issue, but instead an administrative and governance issue that wasn't getting addressed by the appropriate authorities, leaving IT administrators without adequate guidance to align their systems. Others detailed struggles in preparing their data warehouses for the impending switch from ICD-9 to ICD-10.

We are happy that it's only one year. We were worried it would be more than that.

Melanie Endicott,
director of HIM solutions, AHIMA

Still, others said their state leadership worried about technical difficulties derailing the delivery of benefits, but have not been able to come up with contingency plans to keep Medicaid payments moving if there were some sort of IT breakdown caused by the switch. One official said his state's Medicaid leadership worried not only about the patients, but also the public-relations nightmare scenario when news media interviewed beneficiaries whose benefits were cut off due to technical issues related to ICD-10 implementation.

Vermont Agency for Human Service Associate Health Care CIO Michael Hall, who led the meeting, told SearchHealthIT afterward he felt the most significant barrier to ICD-10 adoption he heard discussed among his peers was the inability to test ICD-10-ready systems before the switchover deadline.

"Both providers and [Medicaid agencies] struggle together with these things to make them happen," Hall said. "The provider community's struggling, we're struggling. We're not struggling in such a way that we can't make it up the hill ... but we're breathing heavy."

Another scary IT scenario, several state Medicaid leaders agreed, would occur if CMS took the approach to ICD-10 as it did with HIPAA 5010 earlier this year: While the agency held the changeover deadline, it delayed enforcement for three months. With ICD, that would create a period of time when providers might submit claims in either coding set, and force resource-strapped states to support both at once.

AHIMA's Endicott agreed that would hold true for the people supporting back-end coding systems for health care providers. "If we [were] to have a staggered [ICD-10 rollout] or a grace period or something like that, I could see all sorts of issues coming up with third-party vendors and the clearinghouses and everybody else involved in the billing and reimbursement process -- not knowing what are we billing for, which system are we using. I think it would cause even more confusion."

The transition to ICD-10 will start on a very basic level, sort of a "crosswalk-type process" from ICD-9 to ICD-10, Charles Lehman, director of Medicaid's state systems division told SearchHealthIT. He imagines it will take some time for state Medicaid agencies to take advantage of the deeper documentation and coding specificity the expanded code set offers.

"It's not just an IT project," Lehman said. "It starts out as an IT project, but in order to really get the benefit of being able to translate the more detailed codes into action to provide better care or adjust payment methodologies, you have to have a lot of good clinical subject matter experts to tell you how you should use these new codes."

Let us know what you think about the story; email Don Fluckinger, Features Writer or contact @DonFluckinger on Twitter.

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