March 30, 2015

The Thrill of Victory, the Agony of Defeat

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Most of those who have been tracking the implementation (or lack thereof) of ICD-10-CM/PCS in the United States are old enough to remember Jim McKay’s melodramatic introduction on ABC’s Wide World of Sports every Saturday afternoon.  “The thrill of victory and the agony of defeat” became part of the fabric of our culture and a national catchphrase often heard to this day. After 40 years of waiting for the implementation of ICD-10, I only wish we could have Jim McKay on the sidelines announcing every turn of the journey.

 

Talk about slow. It was 1979 when American hospitals converted to ICD-9-CM coding. Health information management (HIM) students and new graduates were thrilled to learn ICD-9, but it was pretty uneventful to anyone other than the HIM professionals responsible for the conversion within their organizations. The big excitement came in 1983, with the implementation of the prospective payment system, which used diagnosis-related groups (DRGs) based on ICD-9-CM diagnosis and procedure codes. It was a time to celebrate your decision to become an expert in ICD-9 coding and DRG reimbursement. HIM was driving reimbursement, and things changed fast. The thrill of victory was that DRGs helped bring HIM directors out of the basement and into the boardroom. 

From 1983 to the release of ICD-10 by the World Health Organization (WHO) in 1993, ICD codes evolved significantly, and for every “stop” and “go” and “hurry up” and delay, I heard “the thrill of victory and the agony of defeat” in my head.

I was on the American Health Information Management Association (AHIMA) board as a director from 2006 to 2008 and remember the thrill of victory felt by HIM professionals when in 2008, HHS published a notice of proposed rule making (NPRM) for adoption of ICD-10 on Oct. 1, 2011. Then in 2009, under the final proposal, there was a change in the compliance date, which was pushed out to Oct. 1, 2013. Conversion to ICD-10 suddenly became a topic of conversation for everyone from the C-suite to the medical staff and more.

I was on the AHIMA board again for three years starting in 2010, serving as chairman of the board/president of AHIMA in 2011, and in that time I became an AHIMA-approved ICD-10 trainer. Everyone in the industry would ask: “When will we really have a compliance date for ICD-10?” And the only answer was to cite the date that we had at the time. It was a roller coaster ride of anticipation and delay and uncertainty. We all experienced the agony of defeat on April 17, 2012, when the U.S. Department of Health and Human Services (HHS) published a proposed rule that would delay the compliance date from 2013 to 2014. Then Congress again delayed the implementation date to (at the earliest) Oct. 1, 2015, after language deeming as such was inserted into the annually approved sustainable growth rate (SGR) or “doc fix” bill without debate over objections. 

So here we are in March 2015, when Congress has put off for two more weeks the passage of legislation to repeal and replace a cost-control formula for Medicare physician spending. The U.S. House of Representatives passed legislation last week that provides a permanent replacement to the SGR. The bill, H.R. 2, the Medicare Access and CHIP Reauthorization Act, did not include any references to ICD-10 implementation or an additional ICD-10 delay. For those who have lived through this for 40 years, you have to dig deep into your faith to trust and believe that we will see ICD-10 introduced this year and not dual coding as an option. The bill now moves to the Senate for consideration; however, the Senate will not vote on the SGR bill for two more weeks. So while all HIM professionals remain diligent in their efforts of reminding their senators, “no more ICD-10 delay,” some fear that an amendment still could be slipped in. 

With a bit of a shock reminiscent of last year, an amendment was recently proposed by Rep. Gary Palmer (R-Ala.) calling for a delay of ICD-10 implementation until Oct. 1, 2017. However, this amendment and other proposed amendments were not added to H.R. 2 after the House Rules Committee voted to close the bill. This could be a sign of possible surprises yet to come, or it may be a victory that the compliance date is set. Regardless, we must remain relentless in all efforts to once and for all experience the thrill of victory with an Oct. 1, 2015 ICD-10 compliance date for all providers! A good friend of mine says the definition of a pessimist is an optimist who has been around for a while. This really sums up how many of us feel at this point.

Keep in mind that we will have to walk this path again for the ICD-11 adoption, so it serves everyone’s best interest that we get the transformation process right this time – and right now, for the sake of the American public.

There is no question that ICD-10 will provide high-integrity data for measuring healthcare quality and safety, and we must facilitate the process in order to achieve accurate and meaningful data collection. It is important that everyone in the healthcare industry is united in their approach to ensure the successful adoption of ICD-10 CM/PCS. It will take all of us to see that the adoption is done right – and right on time. 

 

Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS

Bonnie Cassidy is a leading HIM executive advisor, focusing her efforts on advancing clinical documentation integrity, risk-adjusted reimbursement, and health information governance. Cassidy was the 2015 chair of the Board of Directors for The Commission on Accreditation for Health Informatics and Information Management (CAHIIM) and the 2011 President /Chair of AHIMA. She is also a fellow of AHIMA, an AHIMA Academy ICD-10-CM/PCS certificate holder, and an ICD-10 ambassador, as well as a fellow of HIMSS and an advanced member of HFMA. Cassidy was honored to be the recipient of the 2014 Distinguished Member Triumph Award from AHIMA and the 2015 Distinguished Member Award from the Georgia Health Information Management Association. She is also a recipient of the Distinguished Member Award from the Ohio Health Information Management Association.

 Bonnie Cassidy has served as an executive with nThrive, Nuance, QuadraMed, the Certification Commission for Healthcare Information Technology (CCHIT), Price Waterhouse, and Ernst & Young, and was a HIM administrator at two major teaching hospitals, including the Cleveland Clinic Foundation. She is a member of the ICD10monitor editorial board and makes frequent appearances on Talk Ten Tuesdays.

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