Earlier this year, the federal government intervened to extend the deadline for hospitals and other healthcare providers to implement a new type of medical coding called ICD-10. Typically, when patients seek treatment at a healthcare provider, those treatments are assigned billing codes so that hospitals, insurance companies, and federal programs like Medicare and Medicaid can make the appropriate payout for each part of the treatment.
US healthcare providers have been on the ICD-9 version of this coding framework since the 1970s, and lag behind the rest of the world in adopting ICD-10. Version 10 is updated to reflect new medical procedures, and new ways of providing and managing care. Healthcare providers in the US were coming up on the compliance deadline for this update, which requires significant retraining and modernization of administrative systems, and many parts of the US healthcare landscape were unsurprisingly lagging behind.
A recent survey of healthcare providers conducted by eHealth Initiative and the American Health Information Management Association (AHIMA), and sponsored by the health IT vendor Edifecs, shows that while few were on pace to meet the original deadline, half of respondents say that the delay will increase implementation costs by 11-25%. The new deadline will be October 1, 2015.
“To the extent that health plans use third-party administrators and other vendors to process health claims, the plan administrator must ensure that the vendors are ready to process claims using ICD-10 codes by the new compliance date,” says Amy Moore, Partner at Covington and Burling. This may turn out to be a tall order for healthcare providers that have shifted resources away from ICD 10 implementation now that they have more time.
Some providers, however, are continuing with implementation. Florida’s largest pediatric facility, Miami Children’s Hospital (MCH) has tapped Xerox for its ICD 10 work, and is moving forward. Xerox has created a coding and training solution that works through each phase of the change management process in addition to providing new coding technology. The offering uses simulation technology, similar to flight simulators pilots use in order to walk staff through the process.
“We’ll be ready when ICD-10 goes live,” said Ed Martinez, chief information officer at MCH.
Moore explains that it could take up to 23 months for payers to test their systems for compliance once they have implemented the updates, so the single year extension isn’t that much time, especially for providers that haven’t started.
“Providers run the risk of losing momentum if they use the extension to take the pressure off,” adds Heather Haugen, PhD and managing director of The Breakaway Group, a Xerox Company. She is working with MCH to implement the Xerox solution. “There is significant training and education required throughout all parts of a provider network. Not all ICD 10 product providers are going to do that the same way, and not all provider systems are created equal.”
ICD 10 is a key part of electronic health record implementation, as whole patient record systems need to be modernized including the billing codes. Sources at other providers say they’ve cancelled consultant contracts like Haugen’s, and are shifting resources away to other projects. As the new deadline approaches, those providers will have to start over, which is adding to implementation costs.
69% of providers in the AHIMA survey note that adding another year and pushing back implementation to 2016 would be catastrophic. Nearly the same percentage 67% say the delays aren’t improving readiness.
“I think you’ve seen some lobbying from providers who are holding back on implementation, and you’ve seen others who just don’t think it’s going to happen,” Haugen says. “It does create a segments in the healthcare system that you don’t find in other countries which operate at a national scale, and that does increase costs through to the US consumer. I think you see that realization at providers that are pushing ahead like MCH, because they’d rather not lose what they have in place. This is one part of a broader modernization effort.”
This reality is paramount for providers and US healthcare consumers. Between new health IT tools, and compliance changes like those in the Affordable Care Act, Meaningful Use guidelines, health information exchange guidelines, failure to implement isn’t really an option. Haugen expects that the educational materials like those put together by the Breakaway Group as a supplement to technology, will continue to expand, leaving providers who don’t act further and further behind.
“The technology is here, and the opportunities are here, but it’s definitely going to take providers a while to work through it. Some of that is a cultural issue, MCH understands that they have a duty to their patients and they have a sense of urgency. That view has really got to come from leadership and work its way through all corners of the organization to be successful,” Haugen said.