Forum members weigh in on the ICD-10 postponement.

On Feb. 24, HFMA's Suzanne Lestina, director, revenue cycle MAP, sent an informal survey to members of the Forum's listserv about the ICD-10 delay, which was announced by the Centers for Medicare & Medicaid Services (CMS) in February.

Nineteen Forum listserv members took the survey. While a small group, the respondents provided some pointed feedback about the ICD-10 delay and their preparations for the major coding change. The majority of respondents thought the delay was positive, but a number pointed out negative consequences of a postponed deadline. 

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Here are highlights from the survey results:

How do you view the delay of the compliance date for ICD-10? Positive or negative?  

Fifty-eight percent of respondents said the delay was positive, and 42 percent said it's negative.

If you view the delay as positive, how long would you prefer the delay? Less than six months? Six months to 1 year? 1 to 2 years? Greater than 2 years? Or indefinitely?  

Of the 12 respondents who answered this question, 71 percent preferred a one- to two-year delay of the ICD-10 deadline. A few respondents selected more than two years, and one chose six months to one year.  

Two respondents would prefer that the project get delayed indefinitely. "Wait and implement ICD-11 when it is ready," wrote one of these respondents. The other respondent commented:  "The version of ICD-10 that CMS has designed is not what Europe and Canada are using. Although it is said that ICD-10 will be used for clinical outcomes and quality, I believe that 150,000 + codes is overkill. How do we even benefit from Europe's and Canada's experience if we're not on the same methodology?"

If you view the delay as negative, what is the impact of the delayed implementation? 

The respondents pointed out a number of possible negative ramifications from the delay, including the loss of a positive momentum:

  • The lost sense of urgency will make it more difficult to get buy-in at all levels
  • Coders who are in schools now are learning ICD-10 and not ICD-9; when they graduate, there will be no work potentially in ICD-10, so they will not only lose skills in ICD-10, they will not be employable as coders in ICD-9 and will further impact the predicted shortage of coders
  • We've already begun planning and some training, and we'll likely have to start some of this over at a later date if there is a delay
  • We have already spent approximately $3 million for the readiness assessment, gap analysis, and are well into the implementation plan
  • The benefits of ICD-10 to reduce costs and improve patient care are delayed; some of the current issues experienced by the healthcare industry are in part due to the delays in implementing ICD-10
  • The transition imposed a code freeze for new ICD-9 codes this year, so there will be no opportunity to provide enhancements or revisions for a whole year to an outdated system
  • ICD-10 will be able to defend medical necessity, assist to set healthcare policy, allow for better risk adjustment of our encounters/public-displayed information, and enable decision making based on procedure-based outcomes

What is your current state of readiness (e.g., internal resources including staff and clinicians, external resources in terms of technology vendors and payers)? No readiness, limited readiness, moderate readiness, significant readiness, or fully ready?  

Almost half of the 19 survey respondents said they were moderately ready, and six chose "limited readiness." Only two said they had achieved a state of significant readiness.

Of the seven respondents who said the ICD-10 delay was negative, six classified themselves as either moderately or significantly ready.

What is (are) your greatest barrier(s) to successful conversion?  

Time and resources was the most frequently cited barrier by respondents, followed quickly by payer readiness and internal hospital readiness (in terms of IT systems as well as coders, physicians, and other staff). "I don't think our payers are ready, as well as some of our IT systems," said one respondent.

One respondent highlighted a major IT challenge: "We learned recently that computer software deficiencies will not be resolved before ICD-10 go-live, and we will need to select and convert to a new system."

Improving documentation and coding was mentioned by a number of respondents. So, too, was education of coders, physicians, and other staff.

One respondent gave a detailed response to the question of barriers: "First, physician documentation in that many EMR's have not reached full maturity with respect to clinical pathways and coding linked documentation. Second, payer preparedness from lack of standardization and enforcement. Our experience with 5010 is evidence that payers, including Medicare and Medicaid, continue to have difficulty with systems and consistent application of electronic claims data."


Publication Date: Tuesday, March 13, 2012