It has been interesting to see the reaction of provider community with respect to the impending ICD10 transition. In a nutshell they fall under three broad categories:
1) those who do not think the transition will ever take place;
2) those who believe that the issue is minimal and their vendors will provide the panacea, and;
3) those who realize that they have a potential disaster on their hand but are too cash and resource starved to be able to seriously do anything about that.
They seem to be equally distributed among these three categories. Now, there are some noted exceptions (i.e., providers who are not only aware of the significance and scope of the transition but also have the capital and executive mandate to carry out the proper strategy for transition), but they are far and few.
Let’s deal with each of these categories, one at a time…
As far as the transition is concerned, it is almost inevitable. CMS is counting on the transition to be a significant part of their overall cost reduction plan and the commercial payers (who in turn are somewhat dependent upon CMS for high risk subsidies etc) are also betting heavily on it. It is clearly reflected by a small fact: initial CMS stated that they were going to stick to I9 based DRGs and don’t intend to go to I10 based DRGs anytime soon, but that changed pretty quickly. Now they are full-steam ahead on I10 based DRGs, a clear reflection of their newly acquired knowledge of what they can achieve in terms of payout reduction leveraging the granularity inherent within I10. One of the most sought after tool within commercial payer community is a I10 based payout modeler, obviously directed at figuring out the potential payout adjustments that can attained using I10.
Now, with respect to low impact level and vendor based resolution, all I want to say is, simply look at the number of processes that are going to be impacted by the change and the number of applications supporting those processes, and one would realize very quickly that there is no silver bullet. The transition will impact everything, from revenue cycle to clinical diagnosis, from ER triaging to HEDIS reporting. Vendors are (if at all they do anything) going to be restricted to their respective isolated applications, which still leaves out the umpteen number of interfaces and peripheral pieces of software that will not be remediated by any vendor. In any case, I10 transition is more of a business issue rather than IT issue. No vendor is going to figure out the potential contract renegotiation on the provider’s behalf.
Lastly, for providers that fall under the third category, there is still hope. The transition, though complex, can be phased out quite smoothly (provided one plans for it early enough) and plenty of automation options are available for impact assessment and tactical remediation to reduce the cost factor significantly. The operative theme though is to plan early and prepare a well defined roadmap, starting with a detailed assessment not only at the business process level but also at the code level.
In conclusion, I would like to say that the payer industry is getting ready for this transition and it is leveraging the state-of-the-art tools to manage their interests and it would behoove the providers to be in the same league lest they want to play it by the ear when it comes to contract renegotiations post October 1st, 2013.
