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The Five Stages of ICD-10 Grief: A Message for Providers

by Hannah Galvin, MD, Senior Manager, Clinical Effectiveness

If you’re a provider like me, chances are your feelings about the ICD-10 transition coming in October falls somewhere within the five stages of grief:

  1. Denial: “Don’t talk to me about ICD-10. I have patients to see."
  2. Anger: “This ICD-10 thing is ridiculous! Can you believe how many codes there are? Who needs a code for ‘burn due to water-skis on fire?’ This is going to take me forever! Those government [expletives] don’t know what it means to be on the front lines practicing medicine! This is entirely unnecessary.”
  3. Bargaining: “They could still delay ICD-10! Look what happened last year. Yes, the SGR repeal passed through the Senate without any ICD-10 delays included, but given the number of state physician groups that lobbying Congress to push ICD-10 to 2017, a delay is still possible!”
  4. Depression: “How am I ever going to manage this along with all these P4P and quality metrics...and still maintain my RVUs? I didn’t go into medicine for this! I feel like I don’t have any control over how I care for patients anymore.”
  5. Acceptance: “There are some frustrating, crazy aspects of ICD-10. But there are some good things, too. For instance, asthma codes are updated from that ancient ‘extrinsic/intrinsic’ mumbo-jumbo to more appropriate terminology in accordance with NHLBI guidelines. I do have to make sure I’m on a certified electronic health record (EHR) that’s prepared for the transition, and take some steps to prepare myself, but I can do this. It may be tough for a little while, but I got through [insert worst rotation of your life] in residency – I can get through anything!"

Of course, at athenahealth, we love talking with those of you in the Acceptance phase, and helping you finalize your preparations and workflows. I would venture to say that a big part of getting to this phase is via the work we have put into our ICD-10 Readiness Center, all backed by our ICD-10 Guarantee.

So, I’d like to talk to the rest of you, those stuck somewhere in the first four phases, struggling with how you are going to get through this transition:

Deniers and Bargainers: This time around, believe it or not, the politics seem to be on the side of ICD-10. (Even despite lawmakers’ most recent attempt to block it indefinitely.)

Groups in favor of transition have been more proactive; those opposed, including the AMA, have been less vocal. Sorry to tell you, deniers and bargainers, it really looks like it’s going to happen this time.

Actually, I’m not sorry. It’s time. Last year’s delay was a metaphor for everything we tell patients not to do.

Here’s what I mean: Imagine the ICD-10 transition was a lifestyle change – say, quitting smoking. As a patient, I really don’t want to quit because I know how painful it’s going to be and I’ve got a lot of other stress in my life right now. I know you’re telling me the benefits to quitting, but I don’t really see them: Hey, I haven’t gotten lung cancer yet, how bad could it be? How about we wait another year?

I don’t mean to classify ICD-9 as a catastrophe. Obviously, it isn’t actively causing the harm of something like tobacco. But what kind of harm is it passively causing by what it’s not doing?

The expanded code set offered by ICD-10 allows us to track quality measures more accurately, particularly those for medical complications and safety issues. In this structured format, the increased detail will help providers and payers better identify patients who could benefit from disease management programs.

Since all other industrialized countries are already on ICD-10, adoption will also help us better share public health data internationally; the value for this became clear with the Ebola outbreak last year. Finally, ICD-10 contributes to our increasing use of data from EHRs for medical research – since we’ll be capturing more detailed data in each ICD-10 code, we have the promise of faster, more cost-effective discovery and clinical advancements. And this level of detail will help providers, payers, and government agencies monitor outcomes, analyze costs and resource utilization, and measure performance, including the progress on national objections such as injury and violence prevention and control.

Angry and Depressed: I hear you.

There are things related to ICD-10 that I’m angry about too – primarily the cost. A recent study found that small practices will spend between $56,639 and $226,105, medium-size practices between $213,364 and $824,735, and large practices between $2 million and $8 million to implement ICD-10. Two-thirds of practices are projected to fall into the upper range of those estimates, incurring costs associated with software upgrades, training, practice assessments, payment disruptions, and productivity losses during and after the transition.

We know that most of you have already put in the lion’s share of that investment, hopefully enlisting the services of a certified EHR vendor who is ready for the transition, assessing your practice and training your staff.

As with all change, the unnerving part is the unknown: How much time it will take me to search for a code (the aforementioned study estimates a 15% increase in physician documentation time) and the extent to which payment will be disrupted. It is also unclear how payers will respond to the increased specificity available. Some may require the code with the maximum specificity; others may reimburse differently for greater vs. less specific codes. 

No matter where you fall along the “five stages,” another ICD-10 delay will not eliminate any headaches, and it’s not going to help with the cost. In fact, it would make the latter worse. CMS estimated that last year’s delay cost the industry an additional $1 billion to $6.6 billion (not including the lost opportunity costs).

So as providers, now’s the time – if you haven’t already – for us to move into the Acceptance stage and search for the  services that best minimize disruptions in workflow, patient care, and reimbursement. Whether we embrace the benefits ICD-10 has to offer or drag ourselves kicking and screaming, the transition, it seems, is inevitable.

The best option is to be as prepared as possible for what is to come. We here at athenahealth are ready so you can be too. I invite you to watch this video to see what I mean.



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Comments

Submitted by Jessica - Thursday, July 23, 2015

Although ICD-10 is giving sleepless nights to healthcare industry, yet it has to be eventually accepted and all must be prepared to embrace this change. it obviously is bringing in more good for the long run.

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