ICD-10 Readiness: Healthcare payers prepare for major disruption

Carl Natale
by Carl Natale

ICD-10 implementation can be a major disruption for many healthcare organizations. Except for healthcare payers.

Ray Desrochers, executive vice president of sales and marketing at HealthEdge, says the payers he talks to see ICD-10 implementation as a non-issue. "The majority of payer organizations are saying that ICD-10 is pretty much a non-event. Because most of them have remediated or on a planned track to remediate."

According to a recent survey of healthcare payers conducted by HealthEdge, 90 percent of respondents said they will be ready for ICD10 compliance by Oct. 1, 2014. The other 10 percent were unsure. No one admitted to not being able to make the deadline.

Desrochers is confident that healthcare payers will be ready. Desrochers says they're confident vendors will be ready and that they can make it work. "Don't get me wrong. Some of it won't be ready, and they say they got a lot of work to do," says Desrochers. "But they seem to feel like they have a path to get there."

But they don't have much that faith that healthcare providers. In that HealthEdge survey, payers said they believe the Centers for Medicare and Medicaid Services (CMS) will extend the deadline again:

  • 27.7 percent said the deadline is the deadline
  • 33.1 percent said maybe the deadline is flexible
  • 39.2 percent said the deadline is likely to change

Remember, healthcare payers are telling Desrochers that they're going to be ready. "On the provider side of the world, it's a different story," says Desrochers. "There's all this angst, anxiety and 'How are we possibly going to deal with it?'  " And the healthcare payers see that as a strong sign that providers won't be ready.

But that's not influencing their timetables for ICD-10 compliance. They see more disruptive changes coming that are so much bigger than medical coding standards. The HealthEdge survey asks what do payers think will be the hottest discussion topics next year. ICD-10 and ICD-11 coding comprise only 6.9 percent of the answers. Healthcare reform, health insurance exchanges (HIXs) and accountable care organizations (ACOs) add up to 90 percent. ACOs and HIEs are part of President Obama's healthcare reform so the Affordable Care Act (ACA) is a major driver of discussion - and panic.

"Now that the election is over - and particularily now that the election is over and it's Obama - there's all this massive level of scrambling going on with people who are saying "Oh I guess healthcare reform is going to stay', " says Desrochers. Since healthcare reform is going to stick, that means healthcare payers need to develop new business models to compete.

ICD-10 coding is just a step toward those business-changing mandates.

The American Medical Association (AMA) may see ICD-10 implementation as an onerous burden, but healthcare payers see it as a non-event.