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Is ICD-10 the Next y2k?

Posted on September 24, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve started to see more and more people comparing ICD-10 to y2k. I think it’s going to be a great comparison for most organizations. Given the lead time for ICD-10, I believe that ICD-10 is going to be a non-event for most of them. Sure, there will be some hiccups along the way, but nothing major to report.

What’s certain to me is that October 1, 2015 will be a total non-event. I know hospitals are already planning their ICD-10 go live parties, but I don’t think there’s going to be much to talk about. Any problems or issues they have with ICD-10 probably won’t be apparent right away. I think that any major issues with ICD-10 won’t come to light until months after ICD-10 is implemented.

Wait for the stories to come out 2-3 months after ICD-10 is implemented. Then, we’ll start hearing about insurance companies that weren’t ready to process ICD-10 claims or had issues with the way they were processing it. Months later we’ll hear about healthcare organizations that aren’t getting paid and are facing cash flow issues. ICD-10’s impact isn’t going to be over on day one like it was for y2k. It’s a very different issue in that regard.

The other reason I don’t think we’ll hear much about ICD-10 issues is that healthcare organizations that run into issues aren’t going to broadcast that fact. Are we really going to hear healthcare organizations chiming in that they botched their ICD-10 implementation, thought it was going to be delayed again, and weren’t ready? I don’t think so. Any problems with ICD-10 are going to be kept private. At least until an organization isn’t getting paid and goes out of business.

I’m sure we’ll have a wave of ICD-10 implementation articles hit on October 1, 2015. My guess is that none of them will be worth reading since there won’t be anything to say. Wait until Thanksgiving and we’ll start to see the real stories about the challenges of the ICD-10 implementation start to hit the wires.

Can We Now Officially Say that ICD-10 Is Going to Happen?

Posted on July 15, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

With the announcement that came a little over a week ago about CMS and AMA working together on ICD-10, does that mean that we can officially say that ICD-10 is going to happen? The ICD-10 Watch blog has a good summary of what CMS committed to do in the announcement:

  • CMS is creating an ICD-10 Ombudsman to deal with healthcare providers’ ICD-10 problems. More on how this will work later.
  • Without using the words “safe harbor” or “grace period,” CMS promises that Medicare will not deny any medical claims “based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.”
  • Quality reporting programs such as Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) will suspend penalties that may result because of lack of specificity.
  • There will be advance payments available if the Medicare system has problems.

The second and fourth items have gotten all the buzz. Most have interpreted that the second one means that CMS won’t deny ICD-10 claims that weren’t done correctly. That’s an overstatement, but it does decrease the number of denied claims that will occur with the switch to ICD-10. The fourth item listed above was a major concern that I raised, but it applied to all payers and not just CMS. So, it’s nice that CMS has addressed the cash flow challenges that slow claims processing of ICD-10 claims will cause, but that still leaves all the other payers.

With the “peace treaty” signed between AMA and CMS, can we finally say that ICD-10 will not be delayed again? One person suggested to me that it just leaves the AHA as a possible opponent that could stop it. However, I also heard it suggested that they weren’t looking for a delay.

While usually avoiding trying to predict the unpredictable Washington, I’m going to say that we can safely assume that ICD-10 will not be delayed again. We might see an overture or two still that tries to delay it, but if I were putting my money down in Vegas I’d put it all on No ICD-10 Delay in 2015. Are you putting your organization’s “bet” in the same place?

Survey: ICD-10 Business Areas of Concern

Posted on April 30, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Each year, NueMD does a survey of providers around ICD-10. 2015 was no exception. You can see the full results of their ICD-10 survey here. They had over 1000 respondents to the survey with the majority of them coming from small practices and 43% of them coming from patient care (DO, MD, DC, NP, RN, etc).

You should take a minute to check out the full results, but this chart from the survey results really caught my eye:

ICD-10 Business Areas of Concern for Doctors

Regardless of whether you’re interested in the results or not, the list of possible areas of concern is worth considering for your organization: Training/Education, Payer Testing, Software Upgrade Cost, Claims Processing, and Compliance Timelines/Deadlines. Are any of these areas a cause for concern with your practice when it comes to ICD-10? My guess is that it has many of you concerned about the switch to ICD-10.

I was glad to see that claims processing was the biggest concern. It should be a concern for doctors and you better prepare for it to be an issue. If you don’t, it’s very likely that you could run into a cash flow issue for your practice.

All signs seem to be pointing towards no more ICD-10 delays. Although, I did hear someone tell me that Congress had 15 (at least somewhere in that range) more opportunities to slip in language to delay ICD-10 again. That’s not likely comforting for healthcare organizations out there. However, I think at this point, organizations need to assume that it’s coming and prepare accordingly. Not doing so could have some dire circumstances come October.

Great ICD-10 Image and Poll

Posted on March 25, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I saw this great graphic on Twitter today which made me laugh:

I have friends in DC with AHIMA trying to make the case to their representatives in Congress that they shouldn’t delay ICD-10. Word on the street is that as of now (subject to change as we saw last year), the SGR fix bill doesn’t contain an ICD-10 delay. Of course, the real challenge with ICD-10 now is the uncertainty of it all.

I thought it might be interesting to see what the readers of EMR and EHR predict for ICD-10. So, here’s a simple ICD-10 poll about whether ICD-10 will be delayed or not.

Athenahealth Goes After Hospitals and Tavenner Steps Down

Posted on January 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There were two big pieces of news this week that I thought I’d discuss. Hopefully you’ll also add your thoughts and insights in the comments.

1. Athenahealth Moves Into Hospital Market With Acquisition Of Atlanta Startup RazorInsights
I thought the announcement of this acquisition was really interesting. Literally the day before this came out, someone asked me what I thought of Athenahealth. After some discussion, they said do you think they’ll take on Epic and Cerner. I quickly responded, “Well, they don’t have an inpatient EHR, so they don’t have a dog in the fight.” Well, now they do have a dog in the fight. Of course, RazorInsights still isn’t a big competitor of Epic and Cerner. However, if I know Jonathan Bush, that’s the ambition. At least that’s what his numerous cloud rants lead you to believe that he thinks he can take down Epic and Cerner with one single word: Cloud. We’ll see what RazorInsights can do under the Athenahealth umbrella.

2. CMS Leader Marilyn Tavenner Steps Down
Neil Versel has a great article covering Tavenner’s departure. His comments are pretty interesting when it comes to her staying low-profile and away from the media during her tenure at CMS. She’s certainly taken a lot of heat from the botched rollout of Healthcare.gov and other programs.

Personally, I’ll most remember her for her promise at HIMSS 2014 that ICD-10 was going to happen and that healthcare organizations better be ready. Of course, we know how that story played out with Congress passing a few lines in the SGR bill to delay ICD-10 another year. Given Tavenner’s promise, I’m quite sure she was blind sided by Congress’ move as well.

I’m not sure her departure is a good or a bad thing for healthcare. I’m sure that the healthcare behemoth will move along like it always has. Best of luck to her wherever she lands. No doubt working in the government in a high profile position is a rather thankless job that usually pays below market wages.

Who do you think will take Tavenner’s position at CMS? Does it matter?

The Real Problem with ICD-10 Delay or ICD-10 #NoDelay

Posted on December 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today, AHIMA put together a really interesting Twitter campaign (they called a Twitter chat, but it wasn’t as much of a chat as a Twitter campaign in my book) where they tweeted about the need for no more delay to ICD-10. You can see what they did by checking out the #nodelay and #ICD10Matters hashtags. They were hitting a number of congressmen really hard. No doubt, their social media people will have seen these messages. We’ll see if that trickles up to the senators and representatives themselves.

On the opposite side is the AMA which is pushing congress for a 2 year delay to ICD-10. Modern Healthcare just published a story that the ICD-10 delay bill was “dead on arrival.” However, that seemed like a link bait headline. When you read the actual story, they suggest that the ICD-10 bill might be dead when it comes to the lame duck session of congress (now through the end of the year). However, it doesn’t address whether congress will choose to incorporate another ICD-10 delay into the SGR fix in 2015 like they did in 2014. That story is still waiting to be played out.

The real problem with all of this is a topic that we’ve discussed over and over here on EMR and EHR. It applied to meaningful use and EHR certification and now it applies just as well to the implementation of ICD-10. No doubt there are proponents and opponents on each side of the ICD-10 debate. Personally, I’ve seen both arguments and I think both sides have an interesting case to make. I don’t think the decision is as clear cut as either sides makes it out to be. If you delay ICD-10 many organizations will be hurt. If you move forward with ICD-10 many organizations will be hurt.

Uncertainty around ICD-10 is the real problem.

What’s worse than going ahead with ICD-10? Uncertainty about whether ICD-10 is going forward or not. What’s worse than delaying ICD-10? Uncertainty about whether ICD-10 is going forward or not. ICD-10 uncertainty is costing healthcare much more than either an ICD-10 delay or a hard and fast ICD-10 go live date.

The US government (yes, that includes all parts of the US government) needs to make a firm decision on whether ICD-10 should be implemented or not. If ICD-10 is going to be the US medical coding future, then we should bite the bullet and implement ICD-10 on schedule. Another delay won’t improve that implementation. If ICD-10 is not of value, then let’s offer some certainty and do away with it completely. Either way, the certainty will be more valuable than our current state of uncertainty.

I’ll admit that I’m not an expert on DC politics. However, I’ve wondered if there’s something the US government could do that would provide this certainty. In 2014, CMS had done everything they could do to provide that certainty. It turns out, they didn’t have the power to make such a promise. Congress undercut them and they got left with egg on their face.

Could Congress pass a bill that would either set the ICD-10 implementation in stone or banish ICD-10 forever? Would that provide healthcare organizations the certainty they need to plan for ICD-10? Or would they just be afraid that the President would do some executive order to delay ICD-10 again? Is there anything that can be done to communicate a clear message on ICD-10’s future?

My gut tells me that if ICD-10 isn’t delayed in the SGR Fix bill next year, then ICD-10 will probably go forward. You’ll notice that probably was the best I could say. Can anyone offer more certainty on the future of ICD-10? I don’t think they can and that’s the problem.

What I do know is that ICD-10 uncertainty is costing healthcare a lot!

If I Were AHIMA and Wanted to Ensure ICD-10 Wasn’t Delayed Again

Posted on September 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been working on my schedule for the AHIMA conference happening at the end of the month (officially I think they call it the AHIMA Convention). As I’ve looked over the various meetings and topics that will be discussed, I’m once again faced with the ICD-10 discussion.

I’ll admit that the ICD-10 discussion feels a little bit like the movie Groundhog Day. A little reminder of the movie (man I need to rewatch it):

Much like Bill Murray, I think we’re entering the same ICD-10 cycle that we were in last year. People warning about the impending implementation of ICD-10. People talking about the need to train on ICD-10. The impact of ICD-10 on revenue, productivity, software, etc etc etc. If it feels like we’ve been through these topics before, it’s because we have.

I previously posted an important question, “What Would Make Us Not Delay ICD-10 in 2015?” Unfortunately, I think the answer to that question is that right now nothing has changed. All of the reasons that someone would want ICD-10 to go forward and all of the reasons that ICD-10 should be delayed are exactly the same. I’d love to hear from people that disagree with me. Although, so far people have only come up with the same reasons that were the same last year.

That doesn’t mean it’s a lost cause for organizations like AHIMA that really want ICD-10 to go forward. They could do something that would change the environment and help ensure that ICD-10 actually happens in 2015. (Note: When we’re talking about DC and congress, nothing is certain, but I think this strategy would change the discussion.)

If I were AHIMA and wanted to push forward the ICD-10 agenda, I’d leverage your passionate community and be sure that the story of ICD-10 was told far and wide. The goal would have to be to create the narrative that delaying ICD-10 would cause irreparable harm to healthcare and to millions of people.

I imagine a series of videos with HIM people telling their stories on the impact of ICD-10 delays. These stories aren’t hard to find. Just start by looking at the AHIMA LinkedIn thread about the 2014 ICD-10 delay. Then engage the AHIMA community in social media and provide them the tools to spread these videos, their own stories, and other pro ICD-10 messages far and wide. Don’t underestimate the power of storytelling.

Also, you have to change the conversation about the impact of ICD-10. Far too many proponents of ICD-10 just talk about how it’s going to impact them individually. These individual stories are powerful when creating a movement, but the people in Washington hear those stories all day every day. They don’t usually change decisions based on a few heartbreaking stories. So, you have to illustrate to those in Washington that the impact of another ICD-10 delay is going to cause some harm to the healthcare system. This is not an easy task.

A well organized effort by AHIMA and other organizations could really gather steam. Enough calls, messages, and letters into Congress and they have to take note. It’s a feature of the way their systems are done. Although, a few responses won’t work. It has to be a real grassroots wave of people talking about how delaying ICD-10 is going to cause major issues. The biggest challenge to this is that it was delayed this year and what was the impact?

Of course, the other option is to hire a lobbyist. They’re going to tell the same story, but in a much more direct way. If AHIMA and other ICD-10 proponents don’t work hard to change the narrative of ICD-10 through a lobbyist or a grass roots campaign, then I don’t see any reason why ICD-10 won’t be delayed again. The good part is that any effort to do this will likely be supported and amplified by organizations like CMS. The bad part is that other organizations like the AMA are fighting the opposite battle. However, being quiet means that the other side wins by default.

EHR Post Acquisition, 2014 Certified, ICD-10 and the Amazing Charts Future with John Squire, President and COO

Posted on April 30, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I had the chance to sit down and interview John Squire, President and COO of Amazing Charts. I was interested to learn about the transition Amazing Charts has experienced after being purchased by Pri-Med and the departure of Amazing Charts Founder, Jonathan Bertman. Plus, I wanted to learn why Amazing Charts wasn’t yet 2014 Certified and their plans to make it a reality. We also talk about the value of meaningful use and the ICD-10 delay. Then, we wrap up with a look at where Amazing Charts is headed in the future.

Check out EHR videos for all of my EHR and Healthcare IT interview videos and be sure to subscribe to the Healthcare Scene youtube channel.

The Job Killing ICD-10 Delay Program

Posted on March 28, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I thought I’d offer a little of my own spin in the headline since those in DC only like to read spin. Unfortunately, I don’t think those in DC will really hear the message and I believe the ICD-10 delay will be passed. I still think that most of congress is voting on the SGR part of the bill and not the ICD-10 delay, but this vote will support the many doctors who don’t want ICD-10 implemented at all ever. This is a strong and large group of doctors that congress does care about.

However, I can’t help but highlight the thousands of coders that will be affected as well. In the link above I quoted a coder who’d paid for the ICD-10 course and now it’s wasted money (and it’s not like coders have a lot of excess income).

Add to that story this story from an educator who switched their educational program to ICD-10. If the ICD-10 delay happens, then all of those newly trained ICD-10 professionals won’t be able to find a job. Read more below from Kelly Fast, MS, RHIA, CMT:

I am a program director of an HIT program in candidacy with CAHIIM. The program began in the summer of 2012. We anticipated we would have graduates this year, the year of the implementation. We went with the assurances from HHS that there would not be another delay. All of our coding curriculum has been taught with ICD-10 (with a nod to ICD-9 from a historical perspective). We now have graduates. As we are all aware, it is so difficult for new graduates to secure coding positions. This delay, if it happens, will definitely not be a competitive advantage for our students! We went with the implementation date sticking and the training in ICD-10 being a positive thing for our students in the workplace. It is so disappointing that this is even being considered.

From the perspective of how many students this will affect nationally — there are over 17,000 students in CAHIIM accredited health information programs.

I think of our students — our job is to prepare them as best we can for the workplace! Are our students going to be given a break on their student loans until October of 2015? I think not. Are our students going to have their loans forgiven when the skill they have gone into debt to learn is a distant memory to them, due to no fault of their own? Again, I think not.

To all students — keep practicing, practicing! At some point the new classification system will be implemented and you will have the opportunity to shine!

So far, AHIMA is keeping the implementation date for the RHIT exam with ICD-10 the same. That is one silver lining for the students. But, yes, this looming delay will have far, far reaching effects. We will be evaluated as a program as to how many of our students pass the exam. So thank you AHIMA for so far not pushing out the date of the switch of the exam from 9 to 10 for the RHIT. Also, we will be evaluated on how many of our students are able to become employed in healthcare. That one will definitely not be helped by any delay.

Also, we had scheduled an area ICD-10 training for next month on our campus. That will be postponed if the Senate passes this bill intact. Just the time and effort in getting all of the leg work done for that has been a lot, and it will all have to be repeated. When you are coordinating large gatherings of people, it isn’t as simple as reworking the dates. When I think about multiplying that effort for training rescheduling over and over for organizations all across the country…wow.

Here’s another personal story that illustrates the personal impact of the ICD-10 delay:

I’d like to chime in as a student about to graduate from an HIT associate degree program. Thank you for all your posts. Like all of you I am shocked by this turn of events. I am a single mom who enrolled in this program after my divorce which pulled the rug from under me and put my kids and I out of our home and, after being a stay at home mom, left me with no income. I’ve worked hard, sacrificed, and have been excited to enter this field that would be a perfect fit for me and would allow me to get back on my feet. I am only trained in ICD10 since the college I attend stopped teaching 9 because of the switch that was supposed to happen this year. I was planning on getting certified and entering the workforce this fall. I need to start earning an income or we could be out on the street. Where will this leave people like me? Congress apparently could care less how they mess with peoples lives. I too have contacted my senator. I pray they will hear us.

Unfortunately, I’m afraid the Congress looks more at the macro and political impact of this bill instead of the personal impact this will have on many people. I hear we’ll have to wait until Monday for the Senate to vote on the bill.

No Shortage of Excitement (This Week) in Healthcare IT

Posted on I Written By

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company's social media strategies for Billian's HealthDATA and Porter Research. She is a regular contributor to a number of healthcare blogs and currently manages social marketing channels for the Health IT Leadership Summit and Technology Association of Georgia’s Health Society. You can find her on Twitter @JennDennard.

When I began contemplating the subject of this blog earlier in the week, I thought I’d make room for thoughts on recent improvements in EMR adoption in the small practice and physician community, and the general state of optimism and enthusiasm some op-ed pieces would have us believe is finally taking hold of the industry. But then came along the potential delay of ICD-10, which also begs a quick comment or two.

A bill that included an effort to delay the ICD-10 compliance date a full year was passed, but only after partisan drama over the fact that legislators received the proposed bill just a day before the vote on it was to take place. I tend to turn to AHIMA on ICD-10 matters, and its official stance is fairly obvious:

ahimaicd10tweet

Its reasoning is similar to that of the Coalition for ICD-10, which in a letter to the CMS, stated: “ … any further delay or deviation from the October 1, 2014, compliance date would be disruptive and costly for health care delivery innovation, payment reform, public health, and health care spending. By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing.

“Moreover, any further delays in adoption of ICD-10 in the U.S. will make it difficult to track new and emerging public health threats. The transition to ICD-10 is time sensitive because of the urgent need to keep up with tracking, identifying, and analyzing new medical services and treatments available to patients. Continued reliance on the increasingly outdated and insufficient ICD-9 coding system is not an option when considering the risk to public health.”

AHIMA has even started a campaign to encourage its constituents to email their senators to urge them to also vote no when it comes to delaying ICD-10. At the time of this writing, the Senate vote is not yet scheduled. I don’t feel the need to restate my support of no further delay. You can read it here.

With regard to the other hot news items of the week, I was intrigued by the findings of the SK&A survey, which found that the EMR adoption rate for single physician practices grew 11.4%. One reason SK&A gave in the survey analysis was due to the “availability of more than 450 different solutions to fit their practice needs, size and budget.” Call me crazy, but I’m willing to bet that many solutions will not exist in the next three to five years thanks to market consolidation. What will these physicians do when their EMR vendor closes up shop? Time will tell, I suppose.