September 24, 2013

The Pauser’s Dilemma

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Hindsight, of course, is always 20-20 . . .

Before continuing, I need to define “pauser,” the rather odd word in the headline. A “pauser” is, to my knowledge, a made-up term I’ll define as:

“An organization that took the potential for, and actual, one-year delay in the ICD-10 implementation date as an opportunity to pause their ICD-10 program, redeploy resources, and focus on other activities.”

We have a number of clients that fall into the category of pausers. Pausers took an ICD-10 hiatus (typically against the advice of several industry groups, consultants, friends, etc.) and now are dealing with the results of those decisions.

It’s worth noting that most healthcare companies that remained steadfast in their ICD-10 program execution and resourcing during the period of uncertainty (and decided to use the delay productively) still are being challenged to get all of the remediation work done in time for the go-live date (which is just slightly more than a year away now). For pausers, however, the situation is even worse.

Such providers are facing several challenges:

1)    How to make up for lost time? At this point, it looks like there will not be another delay, and we have a fixed date. Many feel as though there will be enforcement “grace periods,” as there were for HIPAA 5010, but this is not definite. There are no silver bullets for this one; the old adage that nine women can’t gestate a baby in one month apiece applies here. Even if external resources were available in droves to apply to a program that is lagging behind, it would be unlikely to solve the problem. As a result, our clients are taking shortcuts (not remediating applications and stepping transactions down, etc.), and this could have negative long-term ramifications.

2)    Where to find resources? The U.S. Department of Labor estimates the national unemployment rate for August 2013 to be around 7.3 percent. However (and obviously), they don’t track the specific unemployment rate for ICD-10-trained professionals, which we would estimate is near zero. Additionally, the pauser now will pay a premium for external resources due to the supply/demand imbalance.

3)    How to assuage the testing concerns of trading partners? Pauser payors and pauser providers (alliteration completely unintentional) will struggle mightily to find strategies that allow them to participate in their trading partners’ testing processes, which can create short- and long-term challenges.

4)    How to mitigate the risks associated with not completing remediation activities on time? Many pausers are wrestling with establishing sub-optimal business processes that would enable them to continue operations in the absence of fully remediated systems. Some of the business processes being contemplated are quite interesting . . .

I don’t mean to pick on pausers (although I do enjoy a good “I told you so!”) Pretty much all of the aforementioned challenges are not unique to pausers, either. In truth, well-intentioned, proactive, non-pauser ICD-10 programs are facing the same issues, to some extent. I’m not sure of many things, but I’m sure the next year is going to be a wild ride.

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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