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ICD-10: Our Testimony to Congress

by Kristi Matus, Executive Vice President and Chief Financial and Administrative Officer

Earlier this week, I appeared before the U.S. Health Subcommittee of the House Energy and Commerce Committee to share athenahealth’s point of view on ICD-10. Our recommendation is simple: Either maintain the current date for ICD-10 implementation or cancel it, once and for all. But providers should not have to endure another time-consuming and costly delay. What do you think? I invite you to read my unedited testimony below, and share your thoughts by tweeting @athenahealth.

Chairman Pitts, Ranking Member Green, Members of the sub-committee, thank you for this opportunity to share our perspective on the important issue of ICD-10 implementation, and its implications for broader, bipartisan health reform efforts.

My name is Kristi Matus. I am the Chief Financial and Administrative Officer for athenahealth, a provider of cloud-based health information technology services to more than 60,000 care providers nation-wide, in all fifty states, connecting care for over sixty million patients. Every one of our clients is on a single, national, internet-based network that we use to connect with them in real time, on a daily basis, much like Amazon, or Facebook, or Google. As you may know, this paradigm is all too rare in healthcare.

Based on our experience of partnering with medical practices to improve efficiency and outcomes, our point of view is simple: it’s decision time. Maintain the current date for ICD-10 implementation, or cancel it, once and for all. Do not allow another delay.

Our nation has an extraordinarily ambitious, largely bipartisan healthcare agenda. From the effort to transition the nation’s care providers to modern technology, to the clear imperative of shifting from the costly fee-for service model to value-based delivery and payment structures, we have collectively resolved to tackle a series of very difficult, complex problems. All with the idea of reducing costs and taking better care of patients. To cite just one particularly timely example, the 21st Century Cures package of initiatives championed by many on this Committee has tremendous potential to improve healthcare, but many of its components assume and depend upon continued technological evolution.

I’m not here to tell you that ICD-10 is a silver bullet. But on the spectrum of the challenges we face in healthcare, ICD-10 is a relatively easy one – the technological equivalent of an upgrade from a simple dictionary to a more complex one. It will be orders of magnitude less difficult than achieving the changes in human behavior necessary for the Meaningful Use program to succeed, or implementing the fundamental evolution in healthcare business models necessary for truly accountable care. Repeatedly delaying the implementation of a relatively simple change calls into question whether we, as a country, are truly committed to improving healthcare and potentially undermines the success of our national healthcare agenda.  

Fortunately, we know that in truth the ICD-10 switch is absolutely possible. Much of the developed world made the switch years ago, including, for example, the Czech Republic, Korea, and Thailand – where according to the World Bank the average annual healthcare spend per capita is $215, compared to nearly $9,000 here in the United States.

At athenahealth, we have already completed the work necessary to ensure that our clients were ready at last year’s deadline, as they will be ready at this year’s. We financially guarantee ICD-10 readiness for each of our tens of thousands of clients. And we are not the only solution.

Many of our clients practice in exactly the kinds of small medical groups that have expressed significant concerns about the changes required to adapt ICD-10. Each new delay only multiplies the financial and emotional costs to such practices, who struggle not only with the implications of a possible code switch, but the persistent uncertainty created by repeated delays. Fear creates stasis, inhibiting progress not only on ICD-10, but also on the other more important systemic reforms I discussed a moment ago.

athenahealth's clients have no reason to fear. Because we are internet-based, we will throw a virtual switch at the moment the ICD-10 requirement goes into effect and every one of our clients will be upgraded at that same moment. There is a solution to the perceived ICD-10 problem, and we certainly are not the only ones who can provide it.

Repeated delays of supposedly firm deadlines – both in ICD-10 and in other health IT programs, like Meaningful Use – make it all too easy for some in our industry to doubt future deadlines. Delays unintentionally create incentives for some vendors to forego the work necessary to prepare for ICD-10, confident that their failure to prepare will not harm their clients because we will continue to kick the can and not really move forward with the reforms that improve efficiency and patient care. This is a damaging cycle of non-performance that will only be broken when the government resolves to stick to the deadlines it communicates.

Either ICD-10 is worth doing, or it is not. If it is, then stick to the deadline this year. There will be some disruption, but our industry and the nation’s care providers will respond and adapt.

If you conclude that the benefits of ICD-10 do not outweigh the potential risks, then cancel the program and focus legislation more aggressively on the few fundamental changes in healthcare that are necessary to cure our current dysfunctional system.

On behalf of athenahealth’s 60,000-plus care provider clients and their many thousands of colleagues I urge you in the strongest possible terms: do not again kick this can down the road. Pull the trigger or pull the plug.
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