Updated on: March 16, 2016

“Keep Calm, Carry-on,” Advises Healthcare Executive

Original story posted on: February 22, 2012

“We don’t have the luxury of waiting to see what CMS [Centers for Medicare & Medicaid Services] will do” about the delay, and the “we” in that sentence applies to everyone involved in ICD-10 transition, including providers, payers and vendors,” Annie Boynton, director, 5010/ICD-10 Communications, UnitedHealth Group, told listeners during today’s HIMSS Week, podcast, produced by icd10monitor.


Boynton, one of the five panelists reporting live from the 2012 Annual HIMSS Conference and Exhibit in Las Vegas, says that those who are “deep in the woods” of (ICD-10) implementation should “keep calm and carry on.” Her remarks came amid the uncertainty and confusion that appear to be the operative words following the Feb. 17 announcement by the Department of Health & Human Services (HHS) that it would delay implementation of ICD-10. The general feeling is that the agency’s talk of delay decreases the seriousness around the implementation.

The other four panelists who offered their observations of participant reactions to the news of impending delay include:

  • Maria Bounos, business development manager, Wolters Kluwer Law & Business
  • Stanley Nachimson, president, Nachimson Advisors, LLC
  • Juliet Santos, Senior Director, HIMSS
  • Lyman Sornberger, executive director of revenue cycle management, Cleveland Clinic Health System

What is CMS Doing Anyway?

Much of the confusion began when HHS issued one announcement, saying it would implement a rulemaking process, but then within minutes, removed that release from its website and issued another one that didn’t include any mention of that process. This, says Santos, is what confused everyone on top of the fact that no one has a guess on how long the delay will be. “It’s the worst possible position to be in because we just don’t know yet,” she says.

“It remains to be seen at this time whether the rulemaking process will happen or not. It sounds as if there will be a process,” continued Santos, “but it may not be an official rule where the healthcare community can respond.”

For his part, Nachimson believes that the only way to change deadline would be through official rule-making. Can HHS change the deadline unofficially? “I think it would be more confusing,” he says.

However, Nachimson also makes a point related to the status of the 5010 implementation, which is a prelude to I-10. “We’re still struggling with 5010 in spite of the fact that the first regulatory deadline of January 1 was delayed until April 1. This may factor into CMS’s decision to delay.”

The 5010 issues must be resolved so that “I-10 codes can be pushed back and forth between plans and providers. As long as people work on 5010 issues they’re not focusing on I-10,” he says.

The one concrete thing that CMS has done is to issue a letter to providers that indicates, says Bounos, that it is “looking at the hard financial data regarding the cost of delaying I-10,” including the impact on jobs. She notes that “I-10 is a job creator, and the country needs to create jobs.” For this and other reasons, the delay “has people in knots,” she said.

Sornberger also has a few other knots: “My greatest fear is that vendors will slow down” because of HHS’s announcement. To ease this fear, he will be proactive and contact all vendors to verify their plans.

Another reality he and Clinic leaders faced relates to the “hard financial data” that CMS is now collected. Sornberger stated that the facility just finalized a budget for full adoption at $26 million. Not to continue with the transition would cost it $37 million. The loss of $10 million should grab CMS’s attention.

Keep on Keeping On

Panelists advise, in Boynton’s word, “people to not stop their work” and those who haven’t started yet should get started. There’s still a need to under understand contracts with vendors, information system changes needed, coder knowledge gap, and the sustainability of clinical documentation improvement programs. All of these steps, says Bounos, “will help bring both I-9 and I-10 success.”

It’s also very important that providers, payers, and vendors let CMS know how this delay would affect them. Tell the agency about the positive aspects of ICD-10 and the potential revenue impact of not implementing it.

The biggest challenge for health systems will be to keep the momentum going with the C-suite (such as chief executive officers [CEOs]), which may be a challenge. However, it’s not the time to pull the plug on implementation plans. Boynton reminds providers, payers and vendors, “There is lots of work to do, and we cannot pause in any shape or form. At the end of the day, it’s about keeping your foot on the gas pedal” because ICD-10 is coming sometime.

Questions Asked

Question: We are just about ready to sign a contract for coder education. Should we still do that? Answer: It’s inevitable that ICD-10 will be implemented eventually and the new system is better for clinical documentation. Sornberger says coder productivity will decline by 50 percent at Cleveland Clinic, so the need for education is obvious. He says, “I would recommend signing.”

Question: Does anyone predict that I-10 will be skipped and I-11 will be used? Answer: It’s unlikely that will happen, Nachimson said. The reason is that the World Health Organization’s version of ICD-11 will not be ready until May 2016. It will take the United States until 2020 to revise it for our use. However, he says, “I-10 is a good stepping stone to I-11.”

Question: HHS said that it will initiate a process to postpone implementation for “certain health entities.” Who are the entities exactly? Answer: Anyone covered under HIPAA is affected by ICD-10 implementation, and vendors aren’t bound. Nachimson believes it was just HHS’s way to acknowledge the legal language initially used.

Tomorrow: More from the HIMSS conference.


Janis Oppelt

Janis keeps the wheel of words rolling for Panacea®'s publishing division. Her roles include researching, writing, and editing newsletters, special reports, and articles for RACMonitor.com and ICD10Monitor.com; coordinating the compliance question of the week; and contributing to the annual book-update process. She has 20 years of experience in topics related to Medicare regulations and compliance.