Pros and Cons of the ICD-10 Delay for Clinical Service Directors

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By USDR

The Medicare sustainable growth rate (SGR), passed in 1997, tied Medicare reimbursements to economic growth. Health care costs have far outpaced economic growth in the intervening years, but instead of reforming Medicare, Congress has voted 17 times to appropriate more money to offset the SGR shortfall.

On March 31, 2014, when Congress approved a bill to fix the SGR shortfall, it seemed to most congressmen like just another day at the office. However, tucked within the bill was a provision to delay ICD-10, a change to medical coding that has been implementing in almost every developed country except the U.S. Most observers speculate that Congress passed the bill without even noting the ICD-10 delay. The delay sucks the momentum out of what clinical services directors (CSD) have been working on for the past several years.

CSDs come from a wide range of backgrounds. A CSD might have a graduate degree in public health, health care administration or in a clinical field, like nursing; in fact, many nursing PhD graduates become CSDs (click here to learn more). CSDs are directly in charge of clinical workflows, and they have in-depth involvement with the ICD-10 transition. Unfortunately, ICD-10 isn’t happening until at least October 2015. While they wait, CSDs should find positive uses for the unexpected extension.

Why the ICD-10 Delay Is Annoying

The ICD-10 delay happens as many providers are implementing new care models, such as value-based purchasing and patient-centered medical homes. Value-based purchasing (VBP), which provides Medicare payments to hospitals based on care quality measures and not on the number of services ordered, requires highly accurate reporting and coding of incidents when patients experience complications from care. According to the Centers for Medicare & Medicaid Services (CMS), before VBP one in seven Medicare recipients experienced an adverse event when undergoing care at a hospital. VBP is an attempt at changing America’s fee-for-service health care model.

Another care model initiative, the patient-centered medical home (PCMH), is designed to provide coordinated, holistic care for patients. Electronic health records (EHR) are crucial tools for keeping patient information available and consistent. As many hospitals implemented the ACA’s Meaningful Use requirements and made changes consistent with the PCMH model, they also purchased EHR software that was ICD-10 ready. Between Meaningful Use, VBP, PCMH and ICD-10, hospitals had a chance to kill four birds with one stone by streamlining their approach to modernization. By delaying a crucial component of that modernization, Congress has created unnecessary complications for many CSDs and hospital administrators.

Making the Best of a Less-Than-Ideal Situation

Although the ICD-10 delay came at a bad time, CSDs and health care administrators can use the delay to make the transition even smoother when it happens. Some suggested steps include:

Improve physician documentation. Medical coding staff using ICD-10 will require much more specific information from doctors, including added details about procedures and complications from certain conditions. CSDs can work with nurses and doctors to improve documentation now so that extrapolating the right code from the patient’s records can be easier for office staff.

Keep testing. The majority of providers and payers were ready to go for the October 2014 ICD-10 switch, but they still worried about potential disruptions to their revenue streams. By continuing to test and even implementing ICD-10 early, hospitals can discover which of their partners and payers are not ready for the transition. They can react to the information accordingly to prevent future disruptions in revenue.

Keep training. Keeping training plans on target will increase user experience with the new codes. CSDs should take a good look at the hospital’s overall plans, including other issues like Meaningful Use, VBP and PCMH. They should see how each initiative overlaps, and construct training plans that eliminate duplicate effort.

The Costs of Delay

Costs for the ICD-10 delay will be high for many hospitals and health groups. “The moving goal line is a significant distraction to providers and inappropriately invokes massive additional investments of time and money for all,” Ed Park, executive VP and COO for Athenahealth, told Health care IT News. Health care administrators and CSDs have also expressed concern that no penalties exist when health care providers fail to meet industry deadlines. Even so, hospitals can make the best of the delay. They can also make sure that lawmakers know how the continued ICD-10 postponements negatively affect patient care initiatives.