What to Expect Before and After ICD-10 Implementation

| | Technology & Integration

ICD10 Are You Ready graphic in UMD Colors

ICD-10 has taken so long to implement that it is hard to imagine anything that hasn’t already been discussed about this big change. But there are still words of wisdom to share and plenty of positives to anticipate.

Highlights of ICD-10’s long road to implementation:

  • ICD-10 was endorsed by the World Health Organization in 1990 (25 years ago).
  • Australia was the first country to fully implement ICD-10 by 1999, and several other countries followed their lead shortly after.
  • In 2009, the Department of Health and Human Services published the final regulation that adopted the ICD-10-CM and ICD-10 PCS code sets.
  • The United States is the only G7 nation that continues to use ICD-9.

What took the U.S. so long to implement ICD-10?

Converting from ICD-9 to ICD-10 presents major challenges, requiring a great deal of preparation and planning. Australia successfully implemented ICD-10 in part because the country’s hospitals have a single diagnosis-related group (DRG). This is not the case for the United States, which has multiple DRGs complicating implementation. The high cost of implementing ICD-10 has had industry stakeholders concerned for several years about whether the benefits of the coding change will outweigh the cost.

A study sponsored by the American Medical Association (AMA) showed implementation costs at almost 3 times more than originally anticipated. Costs for a small practice conversion are around $226,000, and large practices can exceed $8 million. Finally, with ICD-11 scheduled for release in 2018, some believe it would make more sense to wait and convert directly to ICD-11. The Center for Medicare and Medicaid Services (CMS) disagrees, indicating that a transition from ICD-9 directly to ICD-11 would be more complex and potentially cost even more to implement.

If workers’ compensation is not required to convert to ICD-10, then why does all this matter?

Maintaining two coding systems is not a sustainable model for the workers’ compensation industry or for healthcare providers. While it is not mandated for workers’ comp to convert by October 1, 2015, it would be costly and a waste of resources to avoid it.

With the specificity of codes that ICD-10 brings, there are many potential benefits for the workers’ compensation industry. For example, when validating an injury claim, less time may be required to obtain additional documentation from providers. In order to realize these benefits, it is critical to train claims processors to execute on those administrative efficiencies. Other cost saving benefits can include better tracking to detect health care fraud and abuse, better quality of care outcomes and improved administrative performance. All of these benefits can result in much needed cost reductions and improved return-to-work outcomes.

Lessons to take with us after October 1, 2015

In contrast to Australia, Canada ran into pitfalls when implementing ICD-10 that negatively impacted productivity. Some reports noted up to a 50 percent loss in productivity. Australia invested heavily in education, training and updating technology, whereas Canada did not. While stakeholders in the US have been frustrated with ICD-10 implementation delays, the industry here is clearly trying to heed the lessons learned that can help us optimize success.

ICD-10 will present an ongoing learning process over the next few years. Here is a closer look at three key factors we can take away from Australia’s successful implementation:

  1. Training – Two years after ICD-10 implementation in other countries, reports show it took approximately 12 weeks for coders to adjust to the new classification system and 4-6 months for a coder’s confidence level to return to normal.
  2. Updated technology – It takes money and resources to incorporate new data and processes into our systems, so we need to continue investing the resources to keep up with technology advancements.
  3. Education – Resistance to change can be a deal breaker for many organizations, so we need employees who are willing to embrace change.

If workers’ comp payers choose not to convert to ICD-10 until mandated, processes will quickly become confusing, and production will slow, as Canada experienced during its transition. Claim costs will increase as coders will be required to translate between two coding languages. These issues may increase regulatory and legal risks to organizations.

Getting on board with ICD-10 will allow workers’ comp payers to begin capturing data in greater detail that can eventually provide answers and improve claims outcomes. With new knowledge to be analyzed, we have the ability to find better workers’ comp claim solutions, create stronger partnerships within the provider community and ultimately help patients get back to enjoying life faster!