ICD-10 Implementation: Top concerns for healthcare providers

Carl Natale
by Carl Natale

ICD-10 is not a new phenomenon in the world. The World Health Organization endorsed adoption in 1990. But the United States has made it very unique and complicated.

And that uniqueness and complication is captured in ICD-10-CM/PCS. "No one has dealt with ICD-10 like we have to," said Jim Jacobs, senior vice president and product management and health information management for QuadraMed,

He's talking about how specific the codes get and the fact they are being used for reimbursement. This is a "high impact transition"

"We believe ICD-10 is much, much larger than Y2K," said Jacobs. "Because this is people, process and  technology. People are going to have to learn a new way of doing business."

That should scare even the bravest HIM executive. But maybe not. "They certainly have some concerns but I would not describe it as panic by any stretch," says Jacobs.

Of all those concerns, what's really important? What follows are some highlights from a conversation with Jacobs about how hospitals are tackling the transition to ICD-10 implementation. It's not an exhaustive list by any stretch but it offers some pretty good insights into what needs to be done.

First, Jacobs says, "time is going to go by really fast." More than two years sounds like plenty of time, but remember this is bigger than Y2K.

So start your process sooner than later. Second, the added granularity and specificity of ICD-10 codes is going to mean more work. The medical coders will be working with more complicated results, and the clinicians will need to improve documentation.

But there is a flip side.

"Specificity I think will drive better and better care," says Jacobs. "If you want to understand outcomes and understand the protocols that are working, the protocols that have measured benefits, then you need quite a bit of specificity."

He gives two examples. "It's not good enough to just say they had a broken bone. You need to talk about which bone, where and what kind of break it was. Because the protocol for a specific episode can vary with all the details."

"Saying someone had a heart attack doesn't really give you enough to go on. Does aspirin help? Do they need a stent? Or do they need bypass surgery?"

Basically, the medical profession needs to understand what is working. They're not getting enough data yet. Third, healthcare providers need to think through the financial impact of  the inevitable productivity loss in their organizations.

"People have not fully thought through, or they're still figuring out what the productivity impact is going to be and what that's going to mean financially," said Jacobs.

And that leads nicely to Jacobs' primary concern. All this process and education is going take staff members away from their usual jobs. That by definition creates a loss of productivity. Jacobs wants his clients to be sufficiently concerned and to be budgeting for the lost time.