Information technology officers and their CEOs will be forced to make some tough choices in the months ahead. On a battlefield, it is called triage.
Health IT leaders have been placed in this unenviable position because of the imminent rollout of the most momentous change in the information technology landscape since Congress authorized spending over $20 billion in 2009 to stimulate adoption of electronic health records.
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.
Many blame their EHR vendors for failing to get their systems up to speed. There is evidence to suggest that's true in some cases since only a small percentage of EHR software vendors have received their second stage certification from the CMS. Yet achieving Stage 2 certification is key to moving rapidly toward interoperability among different care locations and further delay—except in true vendor-driven hardship cases—would needlessly delay the goals of the larger EHR project.
ICD-10 conversion and the next phase of EHR adoption aren't the only demands being made on healthcare IT officials. Both government payers and private insurers are pursuing new reimbursement models based on sharing savings from cost-cutting and bundled payments for episodes of care. Capitated payment is on the horizon.
As these demands for lower spending escalate, chief medical officers are demanding IT departments deliver better data for measuring quality processes, adverse safety events and outcomes. IT departments are now expected to routinely generate reports that identify the specific patients who generate the most costs and the specific physicians who are practicing outside standardized protocols.
As these demands escalate and budgets get tighter, choices must be made; 2014 is going to be a tough year to be a CIO.
Merrill Goozner is the editor of Modern Healthcare.
Follow Merrill Goozner on Twitter: @MHgoozner
Send us a letter
Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.
