ICD-10, shorthand for the 10th revision of the International Statistical Classification of Diseases and Related Health Problems, is next generation coding for reporting medical diagnoses and inpatient procedures. It will be used not just for billing, but for measuring quality and, increasingly, for population health management.
Full implementation has already been delayed once, even though most other advanced industrial countries began using variations of ICD-10 more than a decade ago. Now, the start-up date is scheduled for Oct. 1, 2014. Officials at last week's meetings of the Medical Group Management Association and the College of Healthcare Information Management Executives agreed that another delay for physician practices and hospitals and hospital systems isn't in the cards.
They have no choice but to get ready. Nothing less than the entire revenue stream of hospitals and affiliated facilities is at stake. Failure to have ICD-10 up and running could result in not getting paid for every service they provide.
Compare that to failure to achieve Stage 2 of the meaningful-use requirements for EHRs, which is the next level of requirements attached to taking government incentive payments. The 16 core measures range from recording a high percentage of medication, lab or imaging services to the use of computerized provider order-entry systems.
The penalties for failing to meet those standards will be assessed based on next year's performance. But those penalties won't be levied until 2016 and start at just 1% of Medicare payments.
Put yourself in an IT manager's shoes. Your institution faces stagnating revenue, and your IT budget isn't going up. You not only have to spend money to train your in-house coders for ICD-10, but must reach out to all the community physicians and practices that feed patients into your system. If they improperly code their patients, nobody gets paid. Compare that to failing to get 1% of revenue in 2016. It's not hard to figure out what will rise to the top of the priority list.
The immediate demands for ICD-10 conversion also are driving the health IT political agenda. All the major provider trade associations—the American Medical Association, the American Hospital Association, the MGMA and CHIME—are pushing for a postponement on the imposition of Stage 2 penalties on EHRs.