Imagine that a federal agency called the Centers for Medicare & Medicaid Services, responsible for insuring about one-third of the nation, tried to build a national health insurance exchange and the rollout was disastrous. Well, we don't have to imagine; it happened. Through wildly poor management that included severely underestimating the complexity of the task, CMS embarrassed itself, and it confused and inconvenienced millions of people. I fear the same scenario will play out with the ICD-10 rollout, because CMS does not appear to have learned a thing from the insurance exchange debacle.