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ICD-10 Postponed, Progress Deferred – How the Industry Buckled Under the Weight of Change

by Todd Rothenhaus, MD, Chief Medical Officer

Last week, to the disappointment of health information technology project managers and consulting firms nationwide, the Department of Health & Human Services (HHS) announced a decision to delay the implementation of ICD-10.

The story broke on February 14, with a comment by the Acting Administrator at the Centers for Medicare and Medicaid Services (CMS), Marilyn Tavenner, at the American Medical Association's National Advocacy Conference in Washington, DC. The AMA had recently argued strenuously to delay ICD-10 owing to the significant administrative burden it would place on providers, so we can’t help but wonder if the AMA begged her to spill the beans at their party.

Two days later, in a clarifying press release, HHS Secretary Kathleen G. Sebelius announced that the department would “initiate a process to postpone the date by which certain health care entities have to comply” with ICD-10. While we still need more clarification. “Certain health care entities” sounds like government speak for HIPAA covered entities but one can’t be sure. But we are fairly sure our clients will not be exempt from the postponement.

HIMSS joined the fray Friday with a late to the party rebuttal of the HHS announcement, calling on HHS to keep to the deadline. We get their point.

Anyone who knows something about running large projects knows that momentum is the key to success. Institutional memory lasts no more than a month or two. Nearly every dollar that has already been spent on ICD-10 will need to be re-spent when the project is taken out of the box again. While the government has grown accustomed to this kind of start-and-stop on giant projects—think expensive bombers and warships—the private sector fires people for decisions like this. It seems an incredible waste to shelve ICD-10, especially since every dollar spent must ultimately come from patient service revenue.

In a way, you can’t blame the government. They’ve created a mess. While one part of HHS is mandating that codes become more granular, the other half—CMS—is joining them up again in the form of hierarchical condition categories (HCC). While providers continue to be required to choose a billing code, Meaningful Use is pushing SNOMED (Systematized Nomenclature of Medicine -- Clinical Terms) for a problem list. ICD-10 running right next to Meaningful Use was a recipe for failure right from the start.

In truth, we at athenahealth are pretty disappointed in the decision.  Like most organizations, we have already invested a boatload of people and time and, like Y2K, HIPAA, ANSI 5010 and Meaningful Use, we knew we were going to make it as painless for our clients as possible. Mandates like these are bellwether opportunities for us to illustrate the failure of the traditional software model and the power of the cloud-based services in helping our clients manage change. We were ready to take on the next big thing.

The real story is that our industry just could not cope with the change. Technology remains so far behind in health care that most vendors just could not shield their clients from the enormity of the transition. If the vendor community at large had its act together, the replacement of one code set for another would not have been so daunting.

But it doesn’t. So it was.

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