ICD-10 may not be postponed for everyone

The Centers for Medicare and Medicaid Services (CMS) blinked last week on ICD-10, but how long will the agency postpone its deadline? One school of thought is that it will be delayed for a year or two; but CMS' announcement mentioned that only "certain healthcare entities" would be granted a reprieve. Which entities? We don't know yet.

Erica Drazen, managing partner, emerging practices, for CSC Consulting, believes it's possible that CMS will require payers to meet the original deadline of Oct. 1, 2013. That doesn't mean that insurers will stop accepting claims coded in ICD-9 on that date, she told FierceHealthIT. But if they must be ready to accept ICD-10 claims by then, that will make it easier for providers to test their systems as they add ICD-10 capabilities.

Referring to the problematic switchover to the 5010 transaction set, Drazen noted, "One of the challenges with 5010 is that everyone went live on the same day. So there weren't any ways to test with partners [in some cases], because you had to have partners who were ready to test with you."

Another possibility, she added, is that CMS "may delay ICD-10 for small and rural hospitals and doctors and not for larger hospitals." If that were to happen, it wouldn't make many of the bigger institutions break a sweat, to judge by interviews that FierceHealthIT has recently done with CIOs.

Drex DeFord, CIO of Seattle Children's Hospital and chair of CHIME, told us that the CMS decision won't affect his hospital's timing for ICD-10 at all. In fact, he said, he was "a little annoyed" by the delay, "just when we're starting to get good traction on ICD-10."

Similarly, Ed Babakanian, CIO of University of California San Diego Health Sciences, which includes the UCSD Medical Center, said, "My goal is to stay on target [for ICD-10]. We're on a very good trajectory to achieve all the dimensions of ICD-10."

These comments underline the disparity between the capabilities of large healthcare systems and those of small community hospitals and physician practices. The healthcare systems and academic medical centers have substantial IT staffs and can afford to hire outside consultants to supplement those teams when they're handling big projects like ICD-10. In contrast, small hospitals have all they can do just to meet their day-to-day operational demands and to achieve Meaningful Use.

Physician practices -- especially those of 10 or fewer doctors -- are facing an even more difficult situation. They may not be able to afford consultants or dedicated health IT staff, but they will encounter many of the same challenges that bigger organizations do in preparing for ICD-10.

That doesn't mean we can or should throw out ICD-10, as the American Medical Association (AMA) demanded before the CMS turnaround. But, as the Medical Group Management Association (MGMA) recently indicated, CMS needs to change its approach to guarantee that physician practices will be capable of making the ICD-10 transition without an undue financial and administrative burden. - Ken