Nearly Half of Leading Healthcare Organizations Are Not Yet Switching to ICD-10-CM

A report by HealthLeaders Media finds that nearly half of healthcare leaders have not yet even begun to prepare for the ICD-10-CM switch. Overwhelmed with competing priorities, hospitals and health plans have not started on ICD-10-CM despite a misguided belief that it will help with their quality improvement efforts (72% of respondents) and a real belief that it will negatively impact revenue for years to come (46% of respondents).

Healthcare reform and the electronic health record are higher priorities. Let's turn off the switch.

Hospitals: ICD-10 Switch Means the EHR Must Wait

The American Hospital Association sent a letter (PDF) to the Healthcare Information Technology (HIT) Policy Committee urging a delay in implementing stage 2 of Meaningful Use criteria for electronic medical records (EMRs), in large part because hospitals are otherwise busy in switching to ICD-10-CM.

Both ICD-10-CM and EMR adoption are unfunded mandates of the federal government, although there are incentives for EMR adoption (non-adoption will eventually result in penalties that come in the form of reduced reimbursements per service). To qualify for incentives for EMR adoption, hospitals must demonstrate "meaningful use", and the federal government has set criteria for it. However, the criteria will become more stringent over time. Currently hospitals must meet "Stage 1" criteria.

The letter is about when "Stage 2" meaningful-use criteria should go into effect. Hospitals are saying that the government should delay stage 2 criteria, because the burden of switching to ICD-10-CM is too high.

As we reported here, hospitals previously asked the government to back off on meaningful use because of the switch to ICD-10-CM.

Of course, we think the EMR is more important, and that ICD-10-CM should take the back seat. Nevertheless, it illustrates one significant effect of the ICD-10-CM switch: delayed adoption of EMRs.

ICD-10 or Meaningful Use? Between a rock and a hard place.

The HIT Policy Steering Committee is debating whether delaying stage 2 of meaningful use would allow healthcare providers more time and resources to negotiate succesfully the switch to ICD-10 (or more precisely, ICD-10-CM and ICD-10-PCS).

The conflict between electronic medical record (EMR) adoption and the switch to ICD-10-CM first surfaced almost immediately after passage of the HITECH Act that incentivizes EMR adoptoin, and is highlighted by a letter from the American Hospital Association and a letter from numerous doctors' organizations.

Despite our prediction that the ICD-10-CM switch would pull resources from meeting MU, it turns out that meeting MU is taking resources from the ICD-10-CM switch.

Now, the HIT Policy Steering Committee is starting to recognize that resource-constrained healthcare providers will have severe difficulties doing both. However, it should have realized this problem much sooner since they certainly were privy to the letters sent above, dated in June, 2009. Almost two years ago!

Now they propose to delay MU "stage 2" criteria, to allow resource-constrained providers to meet the ICD-10-CM mandate.

Why not propose instead that the switch to ICD-10-CM be postponed or even canceled?

Granted, they can only control directly the timing of stage 2 MU, but surely the members of the Steering Committee have some influence with decision makers in Health and Human Services?

Doctors spending on EMRs instead of ICD-10-CM switch

As I noted in a previous post, doctors have insufficient resources to both adopt electronic medical records and switch to ICD-10-CM.

As this story indicates, doctors have been focusing resources on meeting the federal government's "meaningful use" criteria for EMRs at the expense of the switch to ICD-10-CM. Specifically, two thirds of physicians responding to a survey reported spending resources on "meaningful use" in favor of ICD-10-CM.

Of course, in my post, I said that the switch would slow down meeting "meaningful use", but it appears that the converse is happening, and that "meaningful use" is slowing down the switch.

Regardless, the switch ought to be deferred to allow physicians to meet "meaningful use".