When CMS said it wouldn't extend the deadline for healthcare organizations to convert to the ICD-10 coding system--only to cave to pressure at the last minute and announce a delay for "certain entities," it reminded Seattle Children's Hospital & Research Institute CIO Drexel DeFord of the long-running "Peanuts" gag in which Lucy unfailingly pulls the football away when Charlie Brown tries to kick it.
But the consensus among DeFord and other experts at a FierceHealthIT breakfast panel on ICD-10 implementation at the Health Information and Management Systems Society conference in Las Vegas this week: CIOs should make an end run around Lucy and stay focused on ICD-10.
Carole McEwan, then ICD-10 migration project manager at St. Louis-based SSM Healthcare, warned that organizations that "sit back" now risk losing valuable momentum. "It could take six months," she said. "[But] if you give people [a year], they're going to go and do something else, and then when the ninth hour comes, they'll rush to get ready again," she said.
"Right now, we're still moving toward the old regulation date, and we'll do that until we get a new date."
CMS isn't doing providers any favor by being vague about when ICD-10 might finally kick in, the panelists agreed.
"[They need to] give us a date," DeFord, who is also the chair of the College of Healthcare Information Management Executives (CHIME), told the crowded room. "A lot of us have made investments and we need to know. The longer they delay it and drag it out, the worse it is for all of us trying to continue on."
DeFord noted that CHIME sent a letter to HHS Secretary Kathleen Sebelius this week expressing a similar sentiment.
"There are a lot of folks who are really struggling still with their executive teams to even get traction on the whole ICD-10 issue," DeFord said. "A lot of us also have made big investments and good progress and need to understand where we're at within the construct of when the [new deadline] will actually be. Will it be six months? A year? Maybe two? Are we just going to wait for ICD-11?"
DeFord said the delay has done little to break his own organization's stride. "When we heard the date was going to be delayed, the initial conversation was 'damn the torpedoes, full steam ahead,'" he said. "I think there are a lot of things we're doing right now--and doing in a particular order--that are good for us, even if we have a long delay with ICD-10."
Roy Foster, director of regulatory compliance at Cerner, talked about the possibility that the U.S. would bypass ICD-10 and skip straight to ICD-11. It makes sense in some ways, he said, but it's unlikely to happen.
ICD-10 codes are based on what medicine in the 1980s, Foster said, while ICD-11 will be based on clinical knowledge of the 2000s. "We're talking about probably a decade before we're ready to do that. I think the conversation will happen," he said, "but I don't see it going beyond talking."
Foster also echoed McEwan's and DeFord's sentiments about maintaining momentum.
"Not to pick on one particular group, but some cardiologists, for example, are probably sitting in the [chief financial officer's] office right now talking about ways to use the money that was set aside for ICD-10," Foster said. "You've got to be very careful, because at this point we don't know how long the delay is going to be. You can't afford to decelerate what you're already doing."
Stephen Stewart, CIO of Henry County Health Center in Mount Pleasant, Iowa, expressed concern about just that proposition at his facility. He said that his major concern was that any extra time eventually allocated by the government ultimately would be needed just to regain lost momentum and focus.
"You don't give up runway you can't get back," Stewart said. "[ICD-10] may get extended a little bit, but it's still a finite amount of runway. We've got from now until however long that is to do an awful lot of work."