Thoughts on ICD-10: Keep Calm and Carry On

September 3, 2013 Written By Frank Speidel, MD

The October 1, 2014, ICD-10 conversion deadline is 12-plus months away, so why does it feel like two minutes until midnight? Only in healthcare and government does such lead time convert to last-second, bug-eyed panic.

Our anxiety will surely worsen before it improves. The months ahead will bring more hand-wringing and an increasing volume of Doomsday-like pronouncements on this topic. But let’s keep calm and carry on, as the popular expression goes, and remember why CMS and many other stakeholders have sought this change in the first place.

The promise of the oft-postponed ICD-10 is that its increased number of characters (three to seven in ICD-10 versus the previous three to five in ICD-9 CM, three to four numbers in ICD-9 procedure codes to seven alphanumeric characters in ICD-10 PCS) will provide for new technologies and diagnoses as well as markedly enhanced specificity in both coding and procedures. Greater granularity should provide improved quality of care, substantial improvement in clinical research and notable amplification in population health management.

For years now we have had the benefit of thoughtful, organized recommendations from consultants and professional organizations on optimal implementation of ICD-10. With some unique variations, a high-altitude summary (more accurately, a distillation) would be:

1. Organize a team with a preliminary budget.
2. Team comprehensively investigates and documents processes involving diagnosis and procedures. Team inventories existing resources for transformation to ICD-10 (GAP analysis) and documents training needs (to my amusement, C-suite employees are seldom identified for ICD-10 training). Budgeting is usually formalized at this time, as well as an implementation timeline.
3. Identified resources — human, software, hardware and consulting — are acquired, turned loose and implementation begins. Intrinsic with these acquisitions is the conduct of internal and external testing prior to “go live."

Many observers recommend securing a contingency cash provision for the transition to ICD-10. Reasonably, one can foresee accounts receivables rising due to the challenges to coders of working in a significantly different system. I believe a greater challenge for organizations will be compliance of providers in providing granular, detailed documentation appropriate for ICD-10.

Improving Physician Acceptance
Unfortunately, some professionals attribute slow and reluctant adaptation of new technology by physicians to arrogance, indifference or simple laziness. As a physician I seldom see these qualities as reasons for technology lethargy.

Physicians, myself included, view information technology as a utility, not an end in itself. The degree to which new technology helps my provision of patient care determines my avidity in adoption. Practicing physicians concerns are rightly focused on the biopsy report for Mrs. Elizabeth Darcy, correcting serum potassium of Mr. Henry Fielding in the ICU and getting a clean tap on Mr. Tom Jones in the ER.

Nor is it simply the inconvenience of the new technology that concerns physicians. Cost concerns are oft-cited by those calling for further delays. At the recent AMA House of Delegates meeting, doctors decried an estimated cost for implementation that ranges from $83,290 to $2.7 million, depending on practice size.

Physician acceptance and adoption of ICD-10 is both profoundly challenging and absolutely essential for successful transformation from ICD-9 to ICD-10. The successful engagement of physicians commands the earliest lead time and the most dedication of resources. As with any IT initiative, the deployment of knowledgeable experts with outstanding human interaction skills is key to effective implementation. The organization's consistent messaging explaining the "why" benefits of ICD-10 is also essential.

The thorough process review required for ICD-10 implementation is, by itself, a benefit. The re-affirming of coding best practices is always instructive for clinicians and improved documentation should result. An accurate, complete, timely diagnosis is at the core of good, quality care. All physicians know and take pride in this.

Is October 1, 2014, too soon? An impossible deadline dictated by unwise policymakers? Hardly. Most forward-thinking health systems are moving down the path toward the conversion, and the laggards still have time to play catch up. That said, let me amend my initial advice. We should carry on, but quickly. After all, the clock is ticking…