D'Arcy Gue

Why the Transition to ICD-10 is in Trouble

April 18, 2013

ICD-10 3 Minute Read

Last week, I read HIMSS’ glowing Leadership Survey report that federal initiatives to push for transition to ICD-10 “are paying off, ” and I was surprised. And concerned. (See my April 10 post.)

HIMSS observed that “87 percent of respondents indicated they expect to complete their conversion to ICD-10 by October 2014.” This ran counter to the trend we are seeing — that many small to mid-size hospitals have taken no substantive steps towards the transition to ICD-10. Then I realized HIMSS asked no questions about the actual progress that healthcare organizations have made to date. Hmmm.

Fortunately, we now have WEDI’s new ICD-10 survey for comparison.  What a different picture the WEDI survey paints — and not a pretty one.

According to the WEDI survey, many healthcare providers, payers and vendors are significantly behind schedule in their transition to ICD-10. This is the case, despite gaining an extra year with the deadline extension to October 1, 2014.transition to icd-10

Worse, WEDI says that the healthcare industry is not making the amount of progress that is needed for a smooth transition to ICD-10 in October 2014.  WEDI is especially concerned about providers, indicating that they are so behind that  “there won’t be enough time for proper end-to-end testing”  WEDI’s warning: “Unless more providers move quickly forward with their implementation efforts, there will be significant disruption on Oct 1, 2014.” 

Some startling findings:

  • Over 40% of providers said “they did not know when they would complete their impact assessment, business changes, and begin external testing.”
  • Few of these have completed needed initial assessments,  or expect to do so in the next 3 to 6 months.  (This will push required business changes out at least several months.)
  • External testing? About half of providers didn’t know when that will occur, though a  third thought testing would start sometime in 2014.

Just under 1000 healthcare professionals, including 788 providers,  responded to WEDI’s very pointed questions about the degree of actual progress their organizations have made towards ICD-10, based on a WEDI/NCHICA timeline of milestones.

Most significantly, the numbers reported in this year’s survey are essentially the same as in WEDI’s 2012 survey. In other words,  a large portion of providers have done little or nothing about ICD-10 since early last year. Providers cited several obstacles — e.g. staffing, budgets, competing priorities, and vendor readiness.

No doubt, these obstacles are significant.  But another obstacle we’re seeing widely  is a lack of understanding, at the executive level, of how immense an undertaking transition to ICD-10 will be. Common remarks heard are: “ICD-10 is a systems vendor issue…or, just an HIM issue…or, not an organizational priority.”

Many hospital leaders also do not yet understand the financial risks of missing the deadline, or of doing a poor job of transition management. The most obvious risk is that claims will not be paid, but there are others:

  • increased claims rejections and denials
  • improper claims payment
  • coding backlogs
  • increased physician queries and compliance issues
  • duplicate claims
  • and more…

Stay tuned for my next post, where I’ll expand upon the risks inherent in transitioning from ICD-9 to ICD-10, and why senior healthcare executives must take action, right now. 

In the meantime, tell us your thoughts – are there other challenges to transitioning to ICD-10 that we didn’t cover?

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