Ready to hit the pause button

The American Medical Association has repeatedly called on the feds to delay for another year the scheduled Oct. 1, 2014 compliance deadline for ICD-10. Meanwhile, the AMA is evaluating a proposal to leapfrog from the ICD-9 codes now in use to ICD-11 codes, which are under development and may be released by the World Health Organization as early as 2015.

Getting ready for ICD-10 was at the top of the mind for many survey respondents this year in questions about their IT priorities.

In this year's Modern Healthcare/Modern Physician Survey of Executive Opinions on Key Information Technology Issues, though, Modern Healthcare also asked healthcare leaders if they support the AMA's position, and 65% of those responding indicated, “Yes.” Just 15% said “No.” The remaining 20% were “Unsure.” Among the “Top 10 Hot Button issues,” achieving ICD-10 readiness was the No. 1 selection, chosen by nearly 45% of survey respondents.

One leader who supports a delay is Tom Hoffman, manager of information services at Wayne Memorial Hospital in Honesdale, Pa.

Hoffman's 104-bed hospital in the rural, northeastern corner of the Keystone State has been gung-ho about meeting health IT challenges. Wayne Memorial is completing its second year as a Stage 1 meaningful user of health information technology under the federal EHR incentive payment program. On the survey, Hoffman predicted that it was “highly likely” his hospital would attain both Stage 2 meaningful use in 2014 and Stage 3 in 2016, while he listed “achieving ICD-10 readiness” among his top four health IT priorities over the next 24 months.

But even one more year's relief from the ICD-10 deadline would be welcome, he says. That's why Hoffman supports at least half of the AMA's position.

“My main reason is because of the meaningful-use Stage 2 time frame coinciding so closely with ICD-10,” he says. “It's more than we can handle all at once.”

One year may be enough of a breather, since it “doesn't seem to be clear” when ICD-11 will be ready, he says. But if ICD-11 is “still possibly four or five years out, as some sources are saying, then, no, it's not even an option.”

Baylor Health Care System, meanwhile, is “working hard to make ICD-10 happen,” says Dr. Joseph Schneider, chief medical information officer and medical director of clinical information at the Dallas-based system. “But smaller hospitals systems or individual hospitals, I can't imagine what they're going through. I don't know how they're going to do it.”

Schneider serves as chairman of the ad hoc health information technology committee of the Texas Medical Association, at 47,000 members, the nation's largest state medical society, which also is on record as opposing the 2014 start date for ICD-10.

“Underlying it all, TMA and I'm sure AMA, we all agree that (ICD-9) has to go; we just need a better and friendlier approach to get to the future, whatever that is,” Schneider says. The AMA study on the feasibility of a leap to ICD-11 is due in May.

HHS has shown flexibility in the past on ICD-10. Last April, it granted a one-year extension from its previous compliance deadline, Oct. 1, 2013, despite the pleadings to stay the course by the American Health Information Management Association, which has been campaigning for an ICD-10 upgrade for more than a decade.

“I feel for the facilities. I lived that life. It wasn't so long that I was on that side,” says AHIMA CEO Lynne Thomas Gordon, a former associate vice president for hospital operations at Children's Hospital at Rush University Medical Center in Chicago. “We're always too busy. But when is a good time?”

“Even when ICD-11 comes, there will still be lots to be done,” Gordon says, and even if the WHO completes its work on time in 2015, “you have to modify it for use in the United States.” That could take years, she says. “We feel we need to go ahead and bite the bullet.”