Updated on: March 14, 2016

And in this corner…ICD-10

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Original story posted on: January 29, 2014

The year ahead is shaping up to be something of a prize fight. You could call it battle of the regulated sectors of the healthcare industry.

 

In the one corner, stands ICD-10, the long awaited coding and classification system mandated by CMS to take effect in October. In the opposite corner, still king and remaining champion, is the federal meaningful use program. Unlike ICD-10, whose implementation by the industry has been marked more by procrastination than anything else, the meaningful use program—which offers financial incentives for adopting clinical I.T.— has been embraced fully.

According to CMS data released early this year, eligible providers and hospitals have shared some $17.7 billion in incentive payments as of November, 2013, with 86 percent of hospitals and 76 percent of eligible professionals participating. The uptake of EHR technology in the ambulatory sector may stand as one of meaningful use’s most pronounced impacts. As late as 2010, not even half of physician practices had adopted EHR technology, and only a small fraction had fully functioning systems—enabling such basic functions as visit summaries, lab results and electronic prescribing (all mandated under meaningful use), according to the Medical Group Management Association.

In contrast, MGMA data and other studies show an industry lagging behind in the software remediation required for ICD-10. Industry procrastination is no surprise, given the government’s historic reluctance to actually enforce its promised ICD-10 deadlines. ICD-10 proponents like to point out how long overdue the new system is, pointing to the fact that the U.S. is the last industrialized nation to adopt it. I wish I had a nickel for every time I’ve heard how precursor ICD-9 is long obsolete and inadequate when it comes to describing advanced procedures and complex diagnoses. That would generate even more cash than the meaningful use program!

In 2014, industry priorities may shift however. That’s because many providers simply lack the wherewithal to tackle ICD-10—which requires software remediation, coder education, and physician documentation training in unprecedented scope. CMS caved in to industry pressure when it moved the ICD-10 deadline to 2014. While the move may have won the industry valuable time to prepare, it cost the government dearly in the credibility department. Further delays, CMS assures us, won’t happen.

That means that providers participating in the meaningful use program—which encompasses a huge swatch of the industry—will face a tough choice this year. They will have to continue meeting their meaningful use metrics, and for those advancing to Stage 2, they will have to deploy newly certified technology. Meaningful use Stage 2, for example, calls for increased patient participation in portals as a communication tool—not only a new workflow for practices, but a cultural shift for patients as well. For the first time, the meaningful use program—which will begin penalizing providers for non-compliance as early as 2015—includes a metric beyond the direct control of the provider.

I have spoken with several industry leaders who, weighing the current state of the industry, contend that when push comes to shove on the regulatory front, meaningful use will cede to ICD-10. It boils down to the preeminence of the revenue cycle over a short-term incentive payment for EHR adoption. It is hard to imagine that providers would prioritize meaningful use over ICD-10, no matter how challenging the latter is. It’s much easier to envision them struggling through ICD-10, rolling the claims dice with large quantities of unspecified codes, and setting the EHR program aside, if only temporarily.

But if you throw in health reform to the regulatory prize fight, the arena becomes even thicker with smoke—and all bets on any fights are off. The Obama administration has already delayed key components of its health insurance reform effort, such as the employer mandate. Well, in March of this year, the individual mandate deadline kicks in, and if participation to date is any indication, there will be a large swatch of the population still uninsured—and presumably, facing penalties for their recalcitrance. Somehow I can’t imagine the administration actually enforcing an individual mandate while letting corporations off the hook.

But if you think the blowback about health insurance rules under ObamaCare was strong, just wait until the other various federal programs begin to overlap, if not clash, on the calendar. There’s no way of knowing how prepared payers—both public and private—are for ICD-10. They’re scrambling too. There’s no way of knowing what will happen to healthcare cash flow either. Years ago, when the erstwhile ICD-10 deadline was on the horizon, I heard a consultant advise a group at HIMSS—only half jokingly—“to stay out of the hospital come October.”

Eventually the perfect storm will hit. We just don’t know when. But maybe I should plan that trip to Canada this fall.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Gary Baldwin

Gary Baldwin has been covering healthcare since the early 1990s. He is now an independent writer and researcher. He served as technology editor for HealthLeaders Media and for Health Data Management for over 10 years. Gary has won seven national editorial recognition awards from the American Society of Business Publication Editors and the American Society of Healthcare Publication Editors. Gary also covered business and information technology for the American Medical Association’s weekly newspaper. He has presented at numerous conferences. He earned a masters degree in journalism from Roosevelt University, Chicago.