Updated on: November 29, -0001

ICD-10: The Home Stretch?

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Original story posted on: February 17, 2014

Is this really the home stretch?

Since the new year began last month, I’ve heard many clients, colleagues, and other acquaintances mention that ICD-10 programs are in the “home stretch.” But I’m not sure I agree.

Dictionary.com declares the term as follows:

home·stretch (noun)

  1. The straight part of a racetrack from the last turn to the finish line
  2. The final phase of any endeavor

No one working at any racetracks I’m aware of is particularly worried about ICD-10 (unless that’s a tongue-in-cheek moniker for some poorly named horse).

One could make the argument that they (or their insurance companies) should be aware of several code set families, however (such as W5519, Other contact with horse, V80010, Animal-rider injured by fall from or being thrown from horse in non-collision accident, etc.) but that’s a bit of a stretch (pun intended).

That being the case, we’re left with the second definition to gauge whether or not ICD-10 is indeed in any sort of home stretch.

With many healthcare companies just starting testing with their trading partners and many others not quite ready for even internal testing, I’d be hard-pressed to say that ICD-10 is in a “final phase.” Even if all payers and all providers and all clearinghouses and all intermediaries and all government entities and all vendors were fully prepped and ready for testing with each other, I’d still be reticent to declare that our clients are truly in the final phase.

From my perspective, we won’t be in the final phases of ICD-10 implementation for several years (and maybe not until ICD-11 is mandated and implemented). In the unlikely event that all “HIPAA-covered entities” are truly and fully prepared by Oct. 1, 2014, and further assuming that there are no grace periods, periods when penalties for noncompliance are not enforced, or any other politically palatable terminology for an extension, the industry will still be digesting ICD-10 for a long, long time. In fact, many of the anticipated benefits from ICD-10 (improved identification of methods of disease/condition management candidates, improved efficacy of disease/condition management programs, enhanced ability to conduct public health surveillance, improved ability to measure and improve healthcare services, increased sensitivity when refining grouping and reimbursement methodologies, etc.) could take years to emerge and still require analytic iterations to get right.

We also believe that most of the providers and payers are much more focused on ICD-10 remediation than they are on operational shifts that will be required to manage the code proliferation associated with ICD-10’s breadth. Assuming that preparations wrap up on time, most healthcare organizations will need to update or create new operational processes and perhaps organizational structures to handle the new code volumes and complexity. The implementation of ICD-10 could take many months or even years to perfect.

To me, the healthcare industry is far from the final phase of the ICD-10 endeavor, and, therefore, not quite in any type of home stretch. We may even find that the finish line is a moving target as October approaches.

About the Author

John Wollman is the Executive Vice President of Healthcare for HighPoint Solutions, a Management and Information Technology consulting firm focused on Healthcare and Life Sciences.  John is responsible for HighPoint’s Healthcare industry group, catering to Payers and Providers.  John is a recognized expert in several healthcare business domains (Reform, HIPAA 5010, ICD-10, Platform Strategy) and technical domains (Master Data Management, Analytics).  Since graduating from Duke University, John has held executive level positions at consulting and technology companies over his 25 years in business.

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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.