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ICD-10 Delay Foments a Culture of Distrust

 |  By Philip Betbeze  
   February 24, 2012

What hasn't been said about the "surprise" decision by the Department of Health and Human Services to extend the existing Oct. 10, 2013, ICD-10 implementation deadline?

Well how about this: Despite the fact that the decision may allow a few organizations more time to meet the deadline, the bigger danger is that it will set back the pace of what many feel is a sorely needed, radical makeover of the healthcare system so that it becomes more transparent, safer, and more fraud-resistant.

Not that ICD-10 implementation by itself will achieve transparency, relief from high costs, and poor quality. It won't. Not by itself, that is.

As you already know, ICD-10 is essentially a coding system that costs a lot to implement, and the returns from using it will largely accrue to payers, according to some. Indeed one of the benefits of the new coding regime, although it's supposed to be revenue-neutral, is that it will be a tool for improved healthcare cost control.

On the other side, there are those who argue convincingly that over time, ICD-10 could improve payment accuracy, allow providers to anticipate higher patient volumes, and deliver reams of data that will help improve quality of care

But what's particularly worrying about last week's announcement that ICD-10 implementation will be delayed is the fact that many, if not most, significant healthcare groups are actually opposed extending the deadline. That might be a first.

In the past, under fee-for service reimbursement, there was very seldom an incentive to being a first mover on new technologies and operational techniques—even if the government set a deadline. When everyone got paid essentially the same for performing healthcare procedures, whether you mailed in your billing or submitted it electronically, a large number of hospitals just goldbricked the deadline as long as they could, knowing it was likely to be extended.

Meeting the deadline just meant you spent your capital dollars in making the conversion—such as is necessary with ICD-10—early. In the old days, all providers would have had to be dragged kicking and screaming into a new operational paradigm.

This time you have big groups complaining vociferously about the delay. I'm talking about HIMSS, as well as hospitals and health systems that decided to lay out the cash and experience the disruption necessary for implementing ICD-10 by the original deadline.

Though it's unusual to have the majority of healthcare bemoaning a deadline extension, the delay itself is nothing different than what has happened ad nauseum since I've been covering healthcare.

The government sets a deadline, bleats on and on about the penalties for missing it, then when the heat gets turned up as the deadline approaches, moves it back. There are legitimate reasons for doing this in all cases. But when it happens every time, providers start to ignore the deadlines, anticipating the delay, as a very vocal bunch clearly has with ICD-10.

What does the government want? No one seems to know. It's running a race, but the rules are ever-malleable. The finish line keeps getting moved back. Sure, there are arbitrary deadlines, but they're often shoved aside because of political considerations.

So what motivates a healthcare provider to invest? To innovate? To move forward?

Certainly not deadlines that have no teeth.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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