As part of our effort to track and help the industry respond to challenges associated with the move from ICD-9 to ICD-10, the HIMSS ICD-10 Task Force is delivering a two-part series to the Business Edge, summarizing the results of interviews with payers, clearinghouses and providers regarding their specific experiences with the change. In November we focused on responses received from payers and clearinghouses regarding their experience during the first 30 days of the transition. This month we are sharing feedback received from providers and hospitals.
Nearly 90 days post-implementation many are referring to the transition from ICD-9 to ICD-10 as a “non-event.” As we reported in last month’s edition of Business Edge, CMS, commercial payers and clearinghouses are all reporting negligible impact to their day-to-day business. HIMSS heard similar accounts during interviews this month with providers representing a variety of types and sizes of healthcare facilities.
All those interviewed credited the relatively smooth transition they have experienced to months, and in some cases, years, of planning, education and preparation. Almost everyone acknowledged an initial hit to their productivity levels, with one organization estimating a full 30% decline; however, each organization also said that by the end of the first month their teams had “found their rhythm,” and production levels have returned to normal. One organization even reported an improvement in productivity of internal coders, citing the effects of extensive training delivered prior to the transition.
When asked about external challenges, there was universal praise for the readiness of payers and clearinghouses. Nearly all of the organizations interviewed cited one or more initial issues with the transition, but the issues appear to have been specific to individual business partners and were quickly resolved. Some providers have seen slight increases in pended or denied claims, but none are exceeding the margins they had anticipated as part of their planning processes; others have said they are not seeing any increases directly related to ICD-10.
Almost all of the organizations are tracking impact to revenue. It’s too early to say that the industry has managed the transition with complete revenue neutrality, but so far the organizations we spoke with say there has been no negative impact on income. They will continue to track this important metric and expect that it will be a full six months before they have a complete picture of what, if any, effect the change is having on overall income.
The number one challenge reported was documentation. As one respondent noted, “Even though we prepared our staff and physicians, there are many nuances to ICD-10 requiring increased documentation. This will certainly require continuing education on an on-going basis.”
Overall, it appears the industry is weathering the transition well. It’s important to note that such success does not happen by accident. Many hours, weeks and months were dedicated to training internal staff and coordinating with external partners to ensure everyone understood how their individual responsibilities would be impacted by the change, review work flow processes and test systems. Clinical documentation staff ensured physicians were trained on the increased demands for specificity under ICD-10, and electronic health record vendors not only readied their own systems, but provided their customers with the tools and resources they needed to prepare their own organizations for success. CMS, HIMSS, AHIMA and others worked to ensure that stakeholders had the tools and resources necessary for a smooth transition. Working together, the industry has weathered one of its most significant changes ever with no significant disruptions to patient care or provider revenue. Congratulations!
HIMSS would like to thank the following organizations for their contributions to this article:
Hoag Memorial Hospital, Huntington Beach, CA
Smurro Chiropractic Clinic, Tacoma, WA
Springhill Medical Center, Mobile, AL
ThedaCare, Appleton, WI
West Med Practice Partners, Purchase, NY
In her role at Xerox, Betty is responsible for MMIS system compliance against Federal and State rules and regulations. Betty is Chair of the HIMSS Business Edge Task Force, Co-Chair of X12 Provider Information and serves on various WEDI Work Groups.
Pam has more than 25 years' healthcare industry experience. As the Senior Director of Health Business Solutions for HIMSS, she oversees the overall management and strategy development for HIMSS Health Business Solutions initiatives.