As promoters of patient safety and guardians of data integrity, health information management (HIM) professionals have dedicated their careers to ensuring the high quality of information in all medical records, paper or electronic. They also have been crusading for the switch to ICD-10 for many years, in large part because they fully understand the ramifications that accompany reliance on an outdated coding system.
Why the delay matters
ICD-10 is an upgrade to the current, outdated diagnosis and procedure coding system. These new codes provide more specificity on the severity of the cases clinicians are treating, which means that the health information being exchanged with health plans that describes patients’ conditions and the services provided to treat those conditions are being more accurately recorded. As a result, ICD-10 is critical to quality metrics and the financial integrity of healthcare organizations nationwide.
The financial hit on HIT
As a result of the delay embedded in the recently passed sustainable growth rate (SGR) bill, HIM professionals, educators, vendors, providers, and payers are losing the benefits of the investments they made in order to prepare for the earlier ICD-10 transition. In fact, the Centers for Medicare & Medicaid Services (CMS) estimates that the one-year delay will cost the healthcare industry between $1 billion and $6.6 billion. Some additional issues include:
- Considerable investments have already been made by healthcare providers, public and private payors, vendors, and academic programs in preparation for the ICD-10 transition.
- The legislative delay of ICD-10 will substantially increase total implementation costs, as HIT expansion requires more systems changes and many previously completed steps will become outdated and will need to be repeated.
- Delay in implementing ICD-10 codes will also delay the move to pay for healthcare on the basis of quality and outcomes, and it also complicates the consumer’s ability to choose high-quality, low-cost healthcare.
The patient impact
Developed in the 1970s, ICD-9 codes do not reflect all of the changes that have taken place in healthcare over the last 40-plus years. Our current code set is missing important new clinical knowledge and contemporary medical terminology, causing a trend of deterioration in health data. In addition, many developed countries throughout the world have already transitioned to ICD-10, meaning that agencies such as the World Health Organization (WHO) cannot accurately track disease and illness trends.
The impact outdated codes have on population health is immense, and as we continue to move toward data exchange and interoperability, the deterioration of data integrity will erode the return on investment for electronic health records (EHRs). Additionally, it:
- Diminishes our ability to measure outcomes, efficacy, and cost savings;
- Impedes our ability to measure our status against global healthcare data; and
- Deters our ability to track and respond to public health threats.
Advocacy for improvement
With each unfortunate delay, organizations such as the American Health Information Management Association (AHIMA) have rallied HIM professionals into advocacy, including the management of a website that enables members to create and send letters to their representatives in Washington, D.C., urging them to move forward with the implementation of ICD-10 (and to oppose any future legislative efforts to delay the code sets). After all, ICD-10 codes are core elements of many health information technology systems, making the conversion necessary to fully realize the benefits of HIT adoption.
The countdown to ICD-10 compliance is upon us. We have 315 days to tee up and launch ICD-10 compliance programs to not only ready but to exceed all expectations for excellence.
About the Author
Bonnie S. Cassidy, MPA, RHIA, FAHIMA, FHIMSS, is the senior director of HIM innovation for Nuance Communications, Inc.
Cassidy is also past president of AHIMA, having served as the 2011 chairman of the Board of Directors. She is an AHIMA Academy ICD-10-CM/PCS certificate holder and ICD-10 ambassador. Ms. Cassidy is serving as the 2014 chairman-elect of the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) Board of Directors and was the recipient of the 2014 AHIMA Distinguished Member Award.
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