Guest post by Jennifer Della’Zanna.
The debate rages on, despite the Department of Health and Human Services (HHS) issuing a rule finalizing Oct. 1, 2015, as the final date for ICD-10 implementation. Why? Because they said there would be absolutely no more delays last year. And the year before that. It’s kind of like a parent who doesn’t follow through with consequences in childrearing. If the child gets away with it once, they’re going to try again. I predict rages against the machine until midnight on Sept. 30, 2015.
I was in the field, one day into a two-day boot camp, in Connecticut. UConn had just made it into the Final Four, and the hotel bar was filled with revelers watching ESPN. I was in my hotel room, on the phone with my husband because the hotel didn’t have C-Span. He gave me a blow-by-blow count of the votes required until the SGR “doc fix” bill would pass because, at the last minute, the bill had been revised to include language affecting ICD-10 implementation.
If it passed, doctors’ reimbursements would not be cut by 24 percent, but ICD-10 would be delayed by at least a year. My husband is a surgeon, so we had a stake on both sides of the fence … or aisle, I suppose. Of course, it passed — it always passes. But what did that mean for all the people I’d taught in the past months, and what would that mean for the class I had to face the next morning, smack dab in the middle of their training? I expected to see my class members just as disheartened as I was and worried about the energy level of the second training day.
It turns out I didn’t even need to bring cookies. Nobody was disappointed. In fact, there seemed to be a collective sigh of relief. And these were the people I thought were ahead of the curve on implementation.
So, I took a poll:
Did they think people not ready for ICD-10 in 2014 would be ready in 2015?
Did they think people who were almost ready would spend the year getting extra-ready?
So, what did the year gain us? Breathing room?
I say it gained us one thing: Fatigue.
Barriers to Change
Fatigue is why there is continued hope for another delay. We’re tired of dealing with it and hope we can delay it until it goes away. The idea of a move to the ICD-10 coding system has been floating around since I was a coding student back in the ’80s. But even the no-really-we’re-going-to-do-it stage has been in play for several years. We’re so swamped in all the conflicting news about the change, we’re paralyzed about actually making it happen.
There are many initiatives and programs going on in medicine today, including:
• Patient Protection and Affordable Care Act (PPACA or “Obamacare”)
• Clinical Quality Measures
• Electronic Health Records/Meaningful Use
• Health Information Exchanges
• Accountable Care Organizations
ICD-10 is not the only change requiring increased documentation, which is what most of my trainees worry about. And it’s not only ICD-10 creating new processes for how we care for our patients, which is another worry for trainees and physicians. All the initiatives and progress in today’s healthcare require the same changes in thinking and upgrades to documentation, but ICD-10 seems to take all the blame. ICD-10 is the biggest outward, abrupt change to the systems in place or phasing into place. The thing is, it’s going to make all these other processes worth more in the long run.
We all know the usual explanations for why we should change:
• No room in the ICD-9
• All other countries are already using it
• Data mining
• Integration with international databases
But the most common reason for not changing? Money. Yes, let’s bring out that great big elephant in the room.
Experts tout numbers both ways: the delay is costing billions, the conversion is costing billions. So, let’s consider, at this point, whatever we do is going to cost billions and stop arguing about cost. I recognize that this is a strange angle, because ICD-10 is the basis of our billing system. When doctors and their staff think about coding, they think about billing. They’re linked in our minds, but we have to unlink them. Billing is a secondary function of the code set, even here in America where it’s used more for billing than in any other country (because most other countries have a single payer system).
I believe that the estimated costs of ICD-10 conversion have been rolled together with the costs for EHR conversions, which has had a similar timeline. Preparing an office for ICD-10 doesn’t have to be an expensive proposition. Coder training is a few hundred dollars per coder, and high-level training should prepare them to train physicians and other stakeholders in the office. There are also free and low-cost training options from a number of vendors, including the federal government. A little detective work and organization will go a long way toward getting an office ready for the change—even one on a shoestring budget.
What about software? Many EHR vendors are incorporating the ICD-10 codes into regular updates at no extra charge to their customers, so there is little outlay of cash there. Books? You should be buying new code books every year anyway, so that’s no different either.
Yes, it’s going to cost money, but business costs money every year. Is it going to cost a lot more than we usually spend every year doing routine updates and training? Not for most of us. And, for those who may be spending a lot updating systems, the government has been very generous with incentives for doing so. So, get over the money part.
Why Move Forward?
There have been reports of a study that showed ICD-10 won’t make much of a difference in our data quality after all, and we should just wait for ICD-11 to come out—just leapfrog over the ICD-10. Not many people know what ICD-11 is going to look like, including me, so I can’t speak to details. However, learning ICD-10 is easy when you already know ICD-9. The guidelines remain largely the same, with a few new concepts. The big differences are the actual codes and — for those of you who don’t code — we don’t memorize codes. We look them up. The process of looking them up remains the same in the new system. I anticipate that knowing ICD-10 will make learning ICD-11 much easier than leapfrogging, and if we make that change when it’s available, we won’t have the same fear about another big change, because we’ll have all survived the first one.
All change brings with it some form of grief, but we can’t keep going on the way we have been. Healthcare won’t get better that way. So, go ahead and blame ICD-10 for all the anxiety over changing to the new code set, but keep going. Make the changes required in anticipation of ICD-10, not because we’re sure it will go into effect (anything is possible at this point, I suppose), but because the changes you’re making are good for your patients. That’s the reason to move forward — to serve our patients better.
Jennifer Della’Zanna, MFA, CHDS, CPC, CGSC, CEHRS has worked in the healthcare industry for 20 years as a medical transcriptionist, receptionist, medical assistant, practice administrator, biller and coding specialist. She has written and edited courses and study guides on medical coding and the use of technology in healthcare. She teaches medical coding and regularly writes feature articles about health issues for online and print publications. Jennifer is active in preparing for the industry transition to ICD-10 as a trainer for the American Academy of Professional Coders (AAPC).