ICD-10 delay: Who benefits?

By Austin Cameron for Healthcare Finance News

It is now official: you must wait until 2015 to use ICD-10 code W6112XA – struck by macaw.

President Barack Obama has indeed signed the SGR patch legislation – which includes another delay of ICD-10 implementation, to Oct. 1, 2015.

Reactions within the healthcare community to news of the impending ICD-10 delay are akin to students’ reactions to a school teacher delaying the final exam: students who felt unprepared are ecstatic and look forward to the extra time to study and prepare. However, students who studied intensively, paid for tutors in the weeks leading up to the exam, and expended great energy making sure their preparation peaked at exam time are frustrated that their momentum went to waste, that they may have to pay for another round of tutors, and they will have to expend more time and resources to have their preparations peak yet again in 2015.

KLAS spoke with over 100 providers for the recently published ICD-10 consulting services report, in which providers revealed who they used for ICD-10 assessments/road maps, implementation/PMO resources, on-site training, eLearning and application testing. KLAS re-contacted several of these providers to ask how the delay will affect their strategy. Their answers are illuminating.

So, who is relieved?

1. Some Ill-Prepared Core Vendors: Not all providers are confident that their core vendors are ready for the transition. One CMIO recently told KLAS, “Our core vendor will be breathing a deep sigh of relief because they are not ready.”
2. CMS and Payers: Many providers report that payers are still not ready for testing. This includes Medicare, which reportedly won’t begin ICD-10 end-to-end testing pilots until the end of July. Regarding CMS, one provider said, “I don’t think CMS is ready, and they are cleverly disguising it by using providers as the reason for the delay.”
3. MGMA, AMA, and Physician Practices: The AMA is against moving to ICD-10 entirely. They estimate the cost of switching to ICD-10 will be between $225,000 and $8 million for physician practices and that it will force many practices out of business. The MGMA said that without CMS leading the testing, “there will be significant increases in cash flow disruptions to practices that will affect the ability to treat patients.”
4. Providers needing more testing, implementations, training or optimization: Several providers KLAS spoke with welcomed the extra time. They said the following:

• “After hearing the announcement, we have breathed a sigh of relief. We will adjust our timeline for training and implementation and revise our plan moving forward.”
• “This allows us to do a thorough mitigation. We will use the extra time redesigning EMR smart tools to make it easier for documenters to provide the needed specificity.” – Anonymous Director of HIM
• “We will finish the end-to-end testing and then stop work until next year, when we will have to bring in another resource to do regression testing and then cutover. We will finish the computer-aided coding implementation along with the crosswalk tool implementation and the dual-coding implementation.”