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ICD-10 Delay Foments a Culture of Distrust

Philip Betbeze, for HealthLeaders Media, February 24, 2012

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 senior leadership editor with HealthLeaders Media.
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6 comments on "ICD-10 Delay Foments a Culture of Distrust"


Dave W. (3/20/2012 at 9:27 AM)
I think many people have overestimated the financial impact of ICD-10 on physicians. For starters, not all physicians use every single code in the ICD-9 book outside of, say, a trauma center. In your standard office setting, I would be amazed if a majority of physicians used every single ICD-9 code in the book. What usually happens is that practices will isolate just those codes that apply to them. The rest is understanding how the structure works so that if a less common code needs to be used, you know how to find it. I fail to see how with ICD-10 would change that practice. Additionally, when a physician is dealing directly with a patient, ICD-10 still changes nothing if they're observing best practices for their medical notes. ICD-10 codes offer greater specificity for any condition like severity and laterality. If a physician is already detailing all of those down in their notes, how will that change? If they are not taking those items into account, then why aren't they? If anything, ICD-10 serves as a reminder of best practices when a physician is dealing with a patient and dealing with their own practice.

Texas Medical Association (2/27/2012 at 10:33 AM)
What this writer leaves out is the one major group opposed to the old deadline: physicians, without whom this great tool won't work. This is just too big of a change at a time when so many other changes are being forced on hundreds of thousands of physician practices that don't have and can't afford the infrastructure that the big players have to make this happen. The delay was absolutely the right thing to do.

Chris Taylor (2/25/2012 at 2:38 PM)
At HIMSS 2012 this week in Las Vegas and this was the common topic of discussion (other than EMR lack of usability). The ICD-10 delay should be seen less as a chance to put off focus than an opportunity to get ahead of the enormous changes that have little to do with the 'translation'. Trading partners are going to need to come to agreements on how to code accurately and in a way that makes sense for both parties. This is a level of collaboration that hasn't existed before. Many companies talk about training underway for staff, but are they addressing ICD-10's need for knowledge of anatomy, pathology, etc.? There is significant risk that the staff that currently code can't simply be trained. Lastly, this change creates process challenges that, unless addressed, will add to the chaos of the change. It will be interesting to see who understands this and who doesn't.