Seizing the Opportunity in the ICD-10 Delay

Innovative thinkers and influential healthcare leaders aren’t relying on the decisions coming out of HHS to determine their strategy.  Despite the fact that many healthcare organizations were on target to transition from ICD-9 to ICD-10, Health and Human Services (HHS) announced it would initiate a process to postpone the date by which certain healthcare entities have to comply with ICD-10.

The details of the delay have not been revealed, but industry experts are speculating that a one-two year delay is in the works.  With only 20 months remaining to the Oct. 1, 2013 deadline, this leaves many organizations in limbo.  Do they continue down the path of ICD-10 adoption, revise plans based on speculation about a new timeline or completely put the initiative on hold?

The leaders in healthcare never limited their thinking to a coding mandate.  They were aligning their ICD-10 efforts with quality of care initiatives- EMR adoption and improved clinical documentation.  They won’t hesitate, they won’t miss a step, and they will focus on providing exceptional care through improved processes, many of which will prepare them for a successful transition to ICD-10 and ICD-11.

The following areas of focus will improve quality of care, reporting and accuracy of reimbursement.

–        Lead with purpose- understand the long-term impact of a coding mandate and help providers understand the alignment of greater specificity in coding with quality reporting, improved clinical documentation and clinical decision support.

–        Take this time to improve clinical documentation– develop processes and feedback to improve how physicians and other providers document care.  This effort will reap financial benefits and directly impact quality of care and reporting.

–        Invest in educating coders– coders will benefit from increased knowledge in anatomy and physiology under any coding system.  Introduce the changes in coding structure that will come with ICD-10 and ICD-11.

–        Appeal to the provider’s intellect- roles and responsibilities continue to evolve in healthcare.  Help the provider understand their role in clinical documentation and responsibility for greater specificity in describing care.

Lead an effort focused on improved clinical documentation, not on coding.  Healthcare leaders who develop a purpose greater than a mandate path will be the clear winners from a quality reporting and reimbursement perspective.  Those who use the delay as another reason to “wait” put their organizations at financial risk and will lag behind the industry leaders with or without a delay.

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5 replies »

  1. Greg and Dr. Carter, I believe we are all in agreement. A focus on clinical documentation today has both short-term and long-term benefits. Additionally, most providers are not interested in a coding mandate, but they are interested in improving quality of care and reporting.

    My conversations with hospital CIOs at HIMSS (last week) were really interesting. Many of them believe the delay will increase the total spend to prepare for ICD-10 because they will likely lose some momentum until the final delay is announced. They may also have some rework for activities that were dependent on the original dates.

    Great discussion, thanks for the comments.

    Heather Haugen PhD
    Corporate VP of Research- The Breakaway Group
    Director of HIT- University of Colorado

  2. Greg,

    You actually make the case for ICD-10 perfectly:

    “But what is the essential benefit behind ICD-10? I would contend it is the force that drives improvements in documentation, and THIS will continue with or without a firm ICD-10 deadline. Our leadership has seen THAT writing on the wall and the message is clear. Improved documentation will drive improved results and increased reimbursements.”

    Your documentation improvements are only grabbing the reimbursement that you organization has been leaving on the table, likely not catching complications and comorbidities or being able to assign higher reimbursement DRGs. The current reimbursement system is based on the broken ICD-9 system, which has literally run out of codes and can’t capture the latest technologies or clinical diagnoses in the record. ICD-10 will allow providers to be better reimbursed based on the real clinical picture, with its finer granularity.

    The benefits also extended to patients. Here’s a link to a discussion on my blog about how ICD-10 can positively impact patient care:

  3. I read many publications that state a delay in ICD-10 will cost providers more than keeping to the original date, but most of this argument is coming from vendors and consultants who have a vested interest in keeping 10/01/13.

    From my perspective the delay is a benefit, although like a worn Band-Aid I would welcome its quick removal.

    Our organization is probably in the middle of the pack in regards to ICD-10 readiness. We have begun investigation into Education, IT and Payer readiness and associated workflows. This is a start and we still have a ton of work to do to be properly prepared.

    But what is the essential benefit behind ICD-10? I would contend it is the force that drives improvements in documentation, and THIS will continue with or without a firm ICD-10 deadline. Our leadership has seen THAT writing on the wall and the message is clear. Improved documentation will drive improved results and increased reimbursements.

    When ICD-10 does become “real”, we will be well prepared and our financial impact swing will be minimal because we have focused on quality documentation that fit ICD-10 standards. We will also keep a keen eye on ICD-11 to assure we pave the road towards smooth adoption of that standard in the possibility it becomes a working reality within the next 8 years.

    If you are a provider that has invested tons of cash into coder education, I am sorry but you may have to spend that money again if the delay is substantial. It is likely that coders will lose this knowledge without regular ICD-10 practice.

    So my question to you (random web traveler to come across this lonely little diatribe), what are the negative implications of a delayed ICD-10? Also, what factors in MU2 rely on ICD-10?


  4. I totally agree that the documentation improvement is the perfect way to bring along all aspects of the organization into preparedness for ICD-10 implementation. This also highlights the startling disconnect in the AMA-spurred CMS decision. ICD-10 preparation is the perfect “grease on the wheels” for EMR and quality initiatives via documentation improvement. Separating them just multiplies headaches.