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WEDI: ICD-10 delay is frustrating, but also an opportunity

- When Congress voted to delay the implementation of ICD-10 by at least a year, the healthcare industry immediately exploded into a cacophony of conflicting opinions.  While some organizations expressed severe disappointment, others took the delay in stride, believing that a few extra months will ensure success for a wider range of stakeholders.

Erik Newlin, Co-chair of the ICD-10 Assessment Workgroup at WEDI and Director of National Standards Consulting at Xerox, sees both sides of the argument: the delay may be exasperating to those who were on their way to compliance, but it will also give payers and providers a better chance to collaborate.

How has the industry reacted to the latest ICD-10 delay?

If you were someone who perhaps was late to the party, or hadn’t invested a lot of time, you might be patting yourself on the back right now and feeling very relieved. For those who were a little further along, they’re really saying, “Oh my God, what’s my new investment look like?  How many additional dollars am I going to have to invest into this to see it through?”

And you also have folks who are struggling with the question of why they should implement anything on time.  Not just ICD-10 but pretty much anything.  Why bother trying to get ahead if we’re going to deal with delay after delay, knowing that attempting to do the right thing on time may eventually cost them more money?

Where are some of the biggest financial liabilities going to appear in the next year?

A lot of the bigger payers began testing late last year, and many of them have been rolling out their external testing plans.  And so those folks have already invested capital, and they have diverted people to handle this particular implementation. Now, the resources that must support that testing period won’t just be needed for the next six months.  They’ll be needed until October of 2015, at least.  You’re adding the cost of labor for those team members as well as the cost for maintaining the technology for so long.  There are a lot of hard questions that folks are going to have to deal with in the next several weeks.

My perception is that payers generally were going to reach the compliance date in 2014, but they may have had different strategies to get there given the short period of time they had left.  With the extra time after the delay, some payers may be looking at different technical solutions and additional options, which is probably a good thing.  They might be able to do more robust translational activities and have more time to test in ways that maybe they wouldn’t have prior. And so perhaps we’ll have fewer issues on the back end.

Many organizations are finding the lack of guidance from CMS to be worrying and frustrating.  What is your opinion of the prolonged silence?

Obviously it wasn’t CMS’s initiative to delay it, and I think they’re at a place where they need to collect as much information as they possibly can before they can provide meaningful input.  True to form, they need that input so that they can provide meaningful information that hopefully helps the industry.

I guess I’m personally okay that CMS hasn’t delivered anything yet. I actually don’t fault them.  They had their plan.  They had their October 1, 2014 date in mind and now someone has changed their plan without giving them a chance to give their input beforehand.  Personally, I think it’s perhaps a little alarming that while our leaders took the time to deliberate on Medicare payments, there was literally no conversation on the floor about ICD-10 in any sense. My concern is that it doesn’t appear to be transparent.

How can providers and payers work together to take advantage of the additional time?

The providers and payers depend on each other completely for this process.  The payers are limited by the time they have to fix the issues they encounter.  The providers need to be able to create accurate, complete claims in ICD-10. And if providers are unable to successfully test with their payers, or if the providers aren’t producing enough different types to test appropriately with the payers, neither party is going to benefit as much as they could from the extra time.

ICD-10 is kind of a self-fulfilling prophecy for providers.  Organizations that are not big on ICD-10, and are expecting it to cause them more issues than it solves, won’t be able to make the changes they need to if they don’t devote the time and resources to something they don’t want to do.   And if the providers aren’t early enough to the game, the payers won’t be able to see what technical issues they need to solve in time.  So whether it actually happens in 2014 or 2015 or 2016, it really doesn’t matter if everyone isn’t working together towards the same goal.

 

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