frustrated docOverall, the news from a recent AHIMA survey on ICD-10 preparation isn’t bad. However, it’s clear that some physicians simply will not be ready next fall, despite having had an additional year to prepare for the changeover.
The American Health Information Management Association (AHIMA) surveyed 454 healthcare organizations in May and June of this year. Seventy-three percent of respondents were healthcare delivery organizations, with acute care hospitals making up 30% of those surveyed and clinics/physician practices making up 25%.
In many areas, the news was positive. A majority of providers (63%) will be ready to conduct testing in 2014; the rest will wait until 2015. According the study authors, “testing is imperative to ensure that trading partners can ultimately accept the ICD-10 coded transactions.” Only 10% of respondents have no plans to conduct end-to-end testing, and 17% don’t know when their organization will be ready for testing. However, 45% of those who don’t plan to test are clinics/physician practices.
“In particular, smaller organizations appear less equipped to address the rigor of end-to-end testing or implement solutions to mitigate the impacts of ICD-10 on staff productivity,” write the study authors. “In addition, prospects for widespread external testing are murky. Many of the survey respondents are unaware of the state of readiness of their peers and business partners, indicating a lack of communication and collaboration about the transition.”
It’s clear that a significant number of healthcare leaders are worried about ICD-10’s impact. Thirty-five percent said they believe their organization’s revenue will decrease during the first year of ICD-10 compliance. Specifically, respondents said they think coding (59%) and documenting (42%) patient encounters and adjudicating reimbursement claims (41%) will be more difficult under ICD-10.
More concerning are responses indicating that smaller practices may have a more difficult time adjusting. “Across the board, a higher percentage of clinics and practices indicated that it would be more difficult to complete common clinical and administrative practices than acute care hospitals,” write the study authors. They go on to report that 61% of clinics and physician practices believe that documenting patient encounters will be harder, as compared to 35% of acute care hospitals. For adjudicating reimbursement claims, 54% of practices think ICD-10 will make the process more difficult, versus 40% of acute care hospitals.
On the plus side, the authors note widespread recognition that although ICD-10 may burden providers and organizations now, it has tangible benefits. “Evolving healthcare payment and delivery models, like accountable care organizations, necessitate improved capacity for measuring performance, cost, and outcomes. Respondents recognize that the increased specificity of ICD-10 is likely to have a positive impact in these areas,” they write.
To that end, an encouraging 70% of organizations are planning to conduct additional training and practice prior to the compliance date. Some respondents are planning to fill staffing gaps in other ways, such as contracting with outsourced coding companies (33%) or purchasing computer-assisted coding technology or similar tools (32%).

Test, collaborate, mitigate

The report authors make three specific recommendations to healthcare leaders as they work toward next fall’s deadline: test early and frequently, collaborate, and mitigate risk prior to implementation. Let’s look at each in detail.
Test. The authors stress that providers should not wait until they are ready to test in an end-to-end environment to begin testing. Rather, they say, stakeholders should test systems as they work with vendors on upgrades and communicate with everyone in the “claims pathway” to ensure their systems function properly. They point out that testing should not focus solely on technical systems but should involve the workflows, processes, and supporting elements necessary to properly use the systems.
Collaborate. It’s important for stakeholders to reach out to peers and other organizations in their region to share best practices, say the authors. They note that some clearinghouses have worked with multiple clients at the same time to send batches of test claims and streamline the testing process.
Mitigate risk. Not surprisingly, the authors advocate dual coding as a way for  organizations to mitigate the risk of the impact of ICD-10. This practice is particularly useful in familiarizing staff with the new code set in advance of implementation, thus improving coding accuracy and productivity. Documentation improvement should be another area of focus, helping to prepare staff for the increased specificity of ICD-10 and highlighting areas where documentation needs to change. “Because the impact of ICD-10 will not be uniform across an organization, operational and/or financial impact assessments can reveal potential variation across service lines and enable the organization to more appropriately target resources prior to implementation,” they write.
With all the concerns fighting for attention these days in provider offices, it’s difficult to focus on a deadline that’s nearly a year away. Still, this survey indicates that many providers will give ICD-10 the attention it deserves to ensure a smooth transition.
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Last Updated on November 19, 2014