After health IT's March madness

Hospitals, physician practices and insurers should continue preparing for the switch to ICD-10 coding, which the government last week postponed for at least 12 months. It will build pressure on Congress and the White House to reverse this terrible decision.

Putting preparations on hold, on the other hand, will send the wrong political signal—that those who lobbied for another delay have a case. They do not.

While the American Medical Association claims it had nothing to do with including the delay in the so-called “doc-fix” bill, the fact remains that the physicians' group favored postponement. It stands virtually alone among healthcare lobbying groups, which banded together in the ICD-10 Coalition to fight further delays. The coalition includes the American Hospital Association, insurers such as Blue Cross and Blue Shield and device and diagnostic test manufacturers.

Stepping up preparations will also signal that supporters of ICD-10 conversion learned the hard lessons taught by the rollout of the federal and state insurance exchanges. Nothing works right out of the box, especially when it comes to information technology.

Last fall, the Obama administration blew the exchange rollout after officials offered six months of sanguine promises that everything was on track for a smooth launch. Contractors were fired. Bureaucrats retired. Some pundits and the law's opponents predicted the CMS and the states would never get it right.

But by the end of the open-enrollment period last week, the president could stand in the White House Rose Garden and proclaim a victory of sorts: over 7 million people had signed up for insurance on the exchanges, as many as had been predicted by the Congressional Budget Office.

Yet the difficulties continue in getting the exchanges operating smoothly. Despite six months of patches and fixes, the federal exchange was overwhelmed and had to shut down for several hours just ahead of the deadline when millions of people began their final frantic search for policies.

The lesson should be plain for information technology departments at hospitals, physician practices and insurers. The switch from ICD-9 to ICD-10 is bound to be as difficult a challenge as the startup of the exchanges.

There are 71,000 coders who belong to the American Health Information Management Association and tens of thousands more who don't. There are hundreds of thousands of doctors. All must be trained to interact with the new system with 68,000 codes, five times the number under ICD-9.

Installing and debugging the software for the new system and training all those people were never going to be easy or cheap. It just got a lot more expensive. The CMS' final rule—now overruled by Congress—estimated that every year of delay would increase the cost of the changeover by as much as 30%. That translates into a $6.6 billion cost for the delay until at least Oct. 1, 2015, according to AHIMA.

Budget managers will be tempted to put purchases on hold; cancel the training; and wait until Congress and the White House decide that the U.S. is finally ready to join the rest of the industrialized world by switching to the more modern medical coding system. That would be a mistake.

Healthcare stands to make tremendous gains switching from a system that was developed in the 1970s and has been repeatedly jerry-rigged to accommodate changes in the practice of medicine.

It will benefit systems' population health management efforts because the greater specificity in diagnoses will help them track trends among their patient populations. It will help physicians gain payment for services previously left uncoded or undercoded, although it may hurt those who used ICD-9's lack of specificity to upcode. Most observers believe the payment impact on Medicare and other insurers will be a wash.

It's easy to make jokes about the greater specificity in the claims records under ICD-10. Yet quick access to richer records, once de-identified, will help a wide range of public health researchers.

Imagine the benefits for a desperate Food and Drug Administration official trying to track the source of a food poisoning outbreak when a screen of medical claims records shows the cause was “foodborne illness-fruit-apples” instead of just “foodborne illness-fruit.”

Healthcare organizations that believe in progress should continue getting ready for ICD-10 while lobbying Congress to reverse this ignorant and ill-considered move.

Follow Merrill Goozner on Twitter: @MHgoozner