Among worries swirling through the healthcare industry is the potential for something of an eleventh hour software mess in which payers and providers are left scrambling to update their IT systems or, even worse, be forced to switch vendors to comply with ICD-10.
The stream of readiness studies by the likes of AHIMA, CMS, WEDI and others suggest that the entire industry — clearinghouses, payers, providers and IT vendors that offer coding tools, EHRs, practice management or revenue cycle software — are lagging.
“The vendors are concerned with provider readiness to accept their ICD-10 products,” Stanley Nachimson, principal at Nachimson Advisors and co-chair of WEDI explained. “Some tend to react to customer demand, which isn’t quite there yet.”
In other words: Everybody's waiting. Many technology makers might be sitting tight until customers come knocking and those clients are, well, perhaps relying on those same IT vendors to drive ICD-10 forward.
That's the perceived image, at least. But will such a nightmare play out in October 2014? Or is there actually time enough to resolve it between now and compliance day?
The answer will likely come down to the size, of both the healthcare organization and the vendors it uses.
For some the ICD-10 ship has sailed
Kaveh Safavi, MD, North America lead of Accenture’s health consulting unit, which tends to work with large IT-savvy healthcare organizations, said that the vendors serving his clients have been planning for ICD-10 literally for years now.
“This is such a long time coming that it’s been in the roadmap and the expectation is that it will all fall into place,” Safavi said. “What’s more, there’s been a significant amount of work running in parallel on the implementation of electronic medical records which, it’s important to note, are the leads to reimbursement systems and revenue cycle systems. Inevitably you have to address ICD-9 and ICD-10 in those implementations. So in many of these organizations ICD-10 is not just a loose appendage. It was a decision already part of the workflow.”
“Of course there are going to be some stragglers out there but if you postpone it another year, it’s going to be the same stragglers another year from now.” — Richard Averill, 3M’s senior vice president of clinical and economic research
Such is the case at Roper St. Francis Healthcare. CIO Mike Taylor said the Charleston, S.C. health system is on the verge of implementing a new EHR and is already considering the go-live date with respect to ICD-10.
One option would be to “let ICD-10 come in and have its impact. We’re going to be doing all the validation testing, dual coding and all that but just to be safe so we don’t impact revenue with a new clinical system, let ICD-10 settle and get all the kinks out while we’re building the clinical system so in 2015 we can automate the physician documentation, and computer-assisted coding along with that, so we take the value of the documentation.”
The other options Taylor is investigating are to implement the new EHR a few months before ICD-10, or even on October 1, 2014.
Likewise, for large networks, “the ICD-10 ship has sailed,” Safavi said, adding that his clients mostly used the last year of delay to bring other projects to the fore that otherwise would have followed the code set conversion.
[Video: ICD-10 Compliance and Beyond: Completing the journey.]
“They didn't need the reprieve but they used it to reorganize priorities,” Safavi said. “They would have been ready this year, truth be told.” Safavi added that the same holds among most technology vendors his clients rely on.
Long game: IT vendors’ product lifecycles
Indeed, as one of the largest ICD-10 vendors 3M Health Information Systems is getting “tremendous pressure to make sure we meet the objective” of having all its software ICD-10 ready by October 2013, according to Richard Averill, 3M’s senior vice president of clinical and economic research.
“We said all our software will be I-10 ready by this October, I think most of it was actually ready last October, and we just do it as part of the normal update,” Averill explained. “It’s no different than every other regulatory update we do each year.”
Even more important is the product development lifecycles that large vendors plot well in advance.
“The question is whether the federal government’s response is ‘that’s your problem’ or the response is ‘that’s our problem.’” — Kaveh Safavi, MD, North America lead of Accenture’s health consulting unit
Looking out at builds for 2014 and beyond Averill said that many software makers literally have no choice at this point but to operate on the belief that ICD-10 will be there, thus forthcoming products must support ICD-10 no matter its ultimate fate.
“The switch has already been made, it’s an I-10 world,” Averill said. “If you want a new product in 2015 you’re updating that now and have to do that in I-10.”
3M, it’s worth pointing out, is the company that CMS contracted to handle the clinical modifications to ICD-10-PCS and, as such, is among the avant garde relative to the coming code sets.
“Of course there are going to be some stragglers out there,” Averill said, “but if you postpone it another year, it’s going to be the same stragglers another year from now.”
The October hustle
Many of those laggards are likely to fall into the very big category of small providers.
Regarding the readiness surveys that gain perhaps an overexposure in the healthcare trade press, Accenture’s Safavi explained that there is a bell-shaped curve and it would be shocking if no one stood up and said they won't be ready.
[See also: ICD-10's long road to population health management.]
“The question,” Safavi began, “is whether the federal government’s response is ‘that’s your problem’ or the response is ‘that’s our problem.’”
Indeed, while large payers and providers with big ICD-10 budgets are moving forward, Safavi and Nachimson asynchronously agreed that the smaller providers who have not started, many of whom are hoping for another delay rather than holding their EHR, practice management or revenue cycle vendors accountable, will be jostling toward compliance when October 1, 2014 draws closer.
Deborah Kohn, principal of DAK Systems Consulting also expects smaller shops to scramble but pointed to recent history as a bellwether and reason to be optimistic.
“The only thing we can base this on is HIPAA 5010,” Kohn explained. “We pretty much got our act together and that was payers, providers, clearinghouses, vendors.”
No one Government Health IT interviewed, including several experts not quoted in this article, suggested even remotely that the ICD-10 transition will happen without problems. Rather, despite predictions of train wrecks, claims denials and cash flow disruption, the industry arrived at 5010 because, also the case with ICD-10, the vendors and their customers knew it was coming.
“ICD-10 is much bigger, of course, but the vendors had to fix for 5010, the providers, payers, clearinghouses, they all had to fix for 5010,” Kohn said. “ICD-10 will cause a blip — but the real question is how big of a blip on the radar will it be?”
Related articles:
How much emergency cash should you keep on hand for ICD-10?
Podcast: Why the U.S. hasn't already moved to ICD-10
ICD-10 and the coming revenue cycle changes
Q&A: Part 2 with 3M's Richard Averill on the politics of ICD-10 timing
