Media Coverage Report“The Final Countdown: Findings from 2014 Survey on Impact of ICD-10”

Released on June 26, 2014 Summary as of July 15, 2015

Results and Highlights

Pitching efforts to key industry media resulted in 16 stories to date highlighting the survey findings - including top tier outlets such as Health Data Management, FierceHealthIT and InformationWeek Healthcare.

Social media reach on Twitter hit nearly 75,000 followers, with over 32 retweets. LinkedIn garnered over 10,000 impressions and 18 interactions with our content , making this the highest performing social campaign in Edifecs’ history – after only 2 weeks!

Social Media Reach Highlights

TWITTER – June 20-July 9, 2014Edifecs has 651 followers

TOTAL SURVEY/WEBINAR TWEETS

RE-TWEETS REACH

21 32 74,415

Tweet River

TWEET FROM: GERRYWIEDERSource: twitter.com, Posted on: Jun 25, 2014 03:12 PM by GerryWieder

RT @KarlWJohnson Edifecs Sponsors Webinar Unveiling Results of a National Survey on the Anticipated Impact of #ICD10 http://t.co/TjYJPxXnIp

Following: 15330 | Followers: 19391 | Updates: 104150 | Sentiment: Neutral

TWEET FROM: SURVIVALPLANKITSource: twitter.com, Posted on: Jun 24, 2014 12:44 PM by SurvivalPlanKit

Edifecs Sponsors Webinar Unveiling Results of a National Survey on the Anticipated Impact of ICD ...: ... publ... http://t.co/NPoYWETJUm

Following: 5824 | Followers: 6858 | Updates: 44826 | Sentiment: Neutral

TWEET FROM: BIOPORTFOLIOSource: twitter.com, Posted on: Jun 30, 2014 12:14 PM by BioPortfolio

News: #Healthcare Edifecs eHI and AHIMA Survey Reveals ICD10 Readiness Concerns Remain But Some Optimism Over Long... http://t.co/LI9c1YbEWt

Following: 1400 | Followers: 4103 | Updates: 50721 | Sentiment: Neutral

TWEET FROM: EDIFECSTODAYSource: twitter.com, Posted on: Jun 26, 2014 06:30 AM by EdifecsToday

WEBINAR TODAY: Ready for ICD-10? Join us at 1PM ET to hear experts from eHi, CMS, AHIMA and Edifecs discuss survey: http://t.co/4Ev6moxx7m

Following: 929 | Followers: 576 | Updates: 1314 | Sentiment: Neutral

June 20-July 9, 2014Edifecs has 5,148 followers

TOTAL POSTS LIKES IMPRESSIONS CLICKS INTERACTIONS5 12 10,061 53 18

Impressions: The number of times each update was shown to LinkedIn members.Clicks: Number of clicks on content, company name or logo (all of which link to the content).Interactions: Number of times people liked, commented on, or shared the content.

Media Coverage – 16 articles

Providers Expect Short-Term Pain from ICD-10 DelayHealth Data Management, Greg Slabodkin, June 27, 2014

While most healthcare organizations are generally prepared to begin ICD-10 testing in the near future, they are concerned about the impact of ICD-10 on workflow, productivity, and reimbursement.

That is the conclusion of a new national survey conducted by the American Health Information Management Association, transactions processing management and testing vendor Edifecs, and the eHealth Initiative.

The survey, conducted in May and June 2014, assesses the anticipated impact of ICD-10, with responses from 349 stakeholders including 101 clinics/physician practices and 115 acute care hospitals or integrated healthcare delivery systems.

When it comes to healthcare organizations utilizing ICD-10 codes with their health IT infrastructure, 45 percent of respondents expressed concerns about interacting with accounting and billing systems, 39 percent with EHR systems, 37 percent with analytics software, and 33 percent with health information exchange.

Overall, in the short term, respondents to the survey believe ICD-10 will make common activities like documenting patient encounters and adjudicating reimbursement more difficult. In the long term, they expect increased specificity to help improve research, population health management, quality and performance measurement, and the accuracy of claims.

During the first year of ICD-10 compliance, 38 percent of respondents believe that revenue will decrease, 14 percent predict revenue will stay neutral, and 6 percent project that revenue will increase. And, 26 percent of healthcare organizations surveyed have not conducted a revenue impact assessment.

Though the one-year delay in the ICD-10 compliance deadline is expected to cost organizations more money, they are using the additional time to prepare their workforce for the transition with 61 percent training more staff.

About 27 percent of respondents say they were ready for ICD-10 testing in the third quarter of 2014, 14 percent believe they will be ready by the fourth quarter of 2014, almost 12 percent report they will be ready in the first quarter of 2015, nearly 10 percent are looking at the second quarter of 2015, and 2.5 percent will be ready in the third quarter of 2015.In addition, a little more than 10 percent of respondents indicate that they have no plans for ICD-10 end-to-end testing whatsoever. It’s interesting to note that 53 percent of those with no plans for end-to-end testing are physician practices and clinics, while only one hospital/ integrated healthcare delivery system has no such plans.

Of the healthcare organizations who are not planning on performing end-to-end testing,  41 percent say they do not know how to perform testing, 14 percent report that testing costs too much, another 14 percent believe testing is unnecessary, and 6 percent report that their business partners will not perform testing with them. Moreover, most respondents don’t have a very good sense of how ready their partners will be for the ICD-10 code switchover.

CMS Developing ICD-10 National Timeline to Help StakeholdersHealth Data Management, Greg Slabodkin, June 27, 2014

The Centers for Medicare and Medicaid Services plans on releasing an ICD-10 “national timeline” to assist stakeholders in preparing for the expected new October 1, 2015 implementation deadline.

With the one-year delay in the ICD-10 code switchover, CMS recognizes that the timelines have changed, particularly as they relate to testing which is a critical component of the transition from ICD-9 to ICD-10. Currently in development, the national ICD-10 timeline will have specific timeframes by which CMS wants all stakeholders ready to test.

“Part of our effort to align industry and regain that momentum is bringing everyone to the table to develop a national ICD-10 timeline,” said Denesecia Green, acting director of the Administrative Simplification Group at CMS, in a June 26 eHealth Initiative webcast. “It’s a commitment from partners across different sectors. We have about 90 partners that we’re lining up now to commit to when they are going to test. We’re going to make that publicly available for the groups that are willing to do that.”

According to Green, CMS found that when clearinghouses and other vendors were ready for ICD-10 testing some of the small providers were not. “I think what this national timeline will do is lay out which payers are going to test and when their testing timeframes are, so groups can prepare to test with them as appropriate,” she added.

A new national survey finds that about 27 percent of providers will be ready for ICD-10 testing in the third quarter of 2014, 14 percent believe they will be ready by the fourth quarter of 2014, almost 12 percent report they will be ready in the first quarter of 2015, nearly 10 percent are looking at the second quarter of 2015, and 2.5 percent will be ready in the third quarter of 2015.

In addition, a little more than 10 percent of respondents to the survey indicate that they have no plans for ICD-10 end-to-end testing. Of the healthcare organizations who are not planning on performing end-to-end testing, 41 percent say they do not know how to perform testing, 14 percent report that testing costs too much, another 14 percent believe testing is unnecessary, and 6 percent report that their business partners will not perform testing with them.

Last month, CMS canceled limited end-to-end ICD-10 testing that had been scheduled for late July, when a small sample group of providers were to have been given the opportunity to participate in end-to-end testing with Medicare Administrative Contractors and the Common Electronic Data Interchange contractor.

"You should see information on end-to-end testing taking place next year. Details will be forthcoming," stated Green. “CMS is supportive of end-to-end testing. We’re encouraging other payers to do the same.” 

Survey Reveals ICD-10 Readiness, But Concerns RemainHealthcare Informatics, Rajiv Leventhal, June 27, 2014

While the majority of organizations are ready to begin testing for ICD-10, 45 percent of respondents don’t have a good sense of their partners’ readiness, according to a new survey conducted by eHealth Initiative (eHI) and the American Health Information Management Association (AHIMA).

The survey, which was sponsored by Edifecs, a Bellevue, Wash.-based global health information technology solutions company, revealed that a majority of healthcare organizations impacted by the mandate are using time afforded by an extended compliance deadline to invest in clinical documentation improvements, workforce training and partner testing, yet concerns over readiness and financial impact remain. Despite the challenges in the short term, most expect the more specific code set to return value in the long run.

Key preliminary findings from the survey include:

• Most organizations are prepared to begin testing in the near future. Forty percent of respondents reported they would begin end-to-end testing by the end of 2014, and 25 percent reported plans to begin by the end of 2015. Of those who stated they had no plans for end-to-end testing, however, 41 percent stated they had no knowledge of how to perform testing.

• Widespread concern about the impact of ICD-10 on workflow, productivity and revenue. Thirty-eight percent of respondents reported they believe revenue will decrease, while 14 percent believe revenue will remain neutral. Only six percent believe revenue will increase.

• Optimism that increased specificity can improve research, population health management and quality/performance measurement and improvement. Respondents answered that common activities such as coding patient encounters, adjudicating reimbursement claims and negotiating contracts between health plans and providers are expected to be more difficult in the short term. Although the long-term impact of the ICD-10 transition is expected to improve care in areas such as accuracy of claims, quality of care and patient safety, not all organizations have a clear plan to derive value from the expanded code set.

• Extensions represent an opportunity for additional training. In order to mitigate productivity loss, 68 percent of respondents stated they plan to conduct additional training and practice, and 31 percent plan to hire more coders to assist with the transition. More organizations are also taking advantage of the compliance transition by training more staff for ICD-10 and improving clinical documentation integrity.

• Clinical documentation integrity is expected to be more difficult. Respondents indicated the task that is expected to be the most difficult post ICD-10 transition is clinical documentation improvement, particularly documenting and coding patient encounters. About 61 percent of respondents report planning to utilize the extension to improve clinical documentation integrity.

• Organizations expect to leverage increased code specificity for claims processing and billing, performance measurement and quality improvement. Respondents stated they plan to leverage the more specific code set for claims processing and billing (65 percent), quality improvement (62 percent) and performance measurement (51 percent).

Survey respondents included vendors, payers, clinic and physician practices, acute care hospital representatives, consulting firm representatives among others. The survey, to date, was distributed to a variety of stakeholders in May/ June 2014 and returned 349 responses.

‘Prime time’ for ICD-10 starts nowHealthcare IT News, Mike Miliard, June 27, 2014

Even if the ICD-10 compliance date is farther away than it once was, it will arrive eventually. (For real, this time. We think.) And while you'd be forgiven for taking a foot of the proverbial gas, this is time that should be spent pushing ahead with preparedness plans.

That's the upshot of a recent survey by eHealth Initiative and AHIMA, which finds that most healthcare organizations are shrewdly using the extra time afforded by the extended October 2015 deadline to invest in clinical documentation improvements, workforce training and partner testing.

But concerns over preparedness and the financial impact remain, and while most organizations said they're ready for ICD-10 testing, they have differing timelines: some are more prepared than others. Forty-five percent of respondents, meanwhile, say they don't have a good sense of their partners' readiness.

"These results show that 'prime time' for ICD-10 preparedness is now through spring 2015," said Sunny Singh, CEO of Edifecs, which sponsored the survey, in a press statement. "Testing is vitally important to establish readiness for the ICD-10 transition and to mitigate any potential revenue impacts."

He added that, "although the mandate has created uncertainties and challenges for all, there is the potential for long-term return in the form of improved claims processing and billing, performance measurement and quality improvement."

Takeaways from the survey, which polled physician practices, hospitals, payers, vendors and others: Some 40 of respondents said they'd start end-to-end testing by the end of 2014, and 25 percent

reported plans to begin by the end of 2015. But of those who stated they had no plans for end-to-end testing, 41 percent said they didn't know how to perform testing.

Another 38 percent thought their revenue would decrease, while 14 percent believed it would hold steady. Just 6 percent thought revenue would increase.

Most organizations thought thought coding patient encounters, adjudicating reimbursement claims and negotiating contracts between payers and providers would get more difficult in the short term.

While the ICD-10 switchover aims to improve accuracy of claims, quality of care and patient safety, not everyone yet has a clear plan to derive value from more granular codes.

In order to mitigate productivity loss, 68 percent of respondents planned to conduct additional training and practice, and 31 percent said they'd hire more coders to assist with the transition.

Clinical documentation improvement was one task that most respondents expect to be the most difficult post-switchover, especially with regard to patient encounters: 61 percent of respondents say they're taking advantage of the deadline extension by training more staff for ICD-10 and improving clinical documentation.

Latest ICD-10 survey shows positives, negativesICD-10 Trainer Blog, Michelle Leppert, June 27, 2014

More healthcare providers would have been ready for an October 1, 2014 ICD-10 implementation date than people may have realized, according to a survey by Edifecs, eHealth Initiative (eHI) and AHIMA.

A total of 349 people responded to the survey, which was conducted in May and June to assess the anticipated impact of ICD-10. Of the respondents, 27.5% worked in acute care hospitals with an equal number working in clinics and physician practices.The results of the survey show both concern and optimism.

First the not-so-good view. A little more than one-third of respondents (38%) believe revenue will decrease in the first year of ICD-10. Only 6% believe revenue will go up and 14% think it will stay the same. More than a quarter of respondents (26%) haven’t done any financial projections.

The majority of respondents (61%) believe coding patient encounters will be harder immediately after implementation, which makes sense and fits with the coder productivity declines seen in other countries.

Forty-four percent said documentation will be more difficult. I’m not sure what to think about that aspect of the transition. Coders and CDI specialists will tell you physicians don’t document well in ICD-9. The diseases aren’t changing, but the documentation requirements for many are. I suspect we will see plenty of additional documentation shortcomings in ICD-10.

That’s not to throw physicians under the bus and blame them. We need to educate them on what we need to see in the documentation. They’re taught to document for other physicians. We need to show them how to document for coding.

Other areas where respondents think things will get more difficult initially include: Adjudicating reimbursement claims (including historical analysis of ICD-9 codes), 41% Analyzing and reporting measures on performance, quality, and safety, 24% Collecting and exchanging health information, 20% Negotiating contracts between health plans and providers, 20%

One-third also believe the efficiency of reimbursement will worsen long term.So that all seems pretty grim, but you’ll notice a light at the end of the tunnel with some other responses. Forty-one percent of respondents think coding will be more accurate in the long term (although they don’t specify what “long term” is).

Quality of care will improve, according to 27% of respondents, and 25% believe patient safety will improve.

Respondents believe the increased specificity will help improve research, population health management, and quality and performance measurement in the long term.

A whopping 68% of the respondents are planning additional training during the delay, which sounds like a wonderful idea. The better coders, CDIs, and physicians understand the requirements of ICD-10, the sooner we will realize the long-term benefits.

Hospital Administrators See ICD-10 as Problematic for Health IT, Survey SaysBloomberg BNA, Alex Ruoff, June 27, 2014

Hospital administrators expect that the anticipated conversion to the ICD-10 (International Classification of Diseases, 10th Revision) code set will immediately make a host of health IT activities more difficult to conduct, according to preliminary results of a new survey of hospitals and physician practices released June 27 by the American Health Information Management Association (AHIMA) and the eHealth Initiative.

According to the survey, the conversion to the new code set, expected for Oct. 1, 2015, will make coding and documenting patient encounters, collecting and exchanging health information and managing risk more difficult for hospital and clinical practice administrators. However, the survey found, administrators also expect the conversion will improve the quality and safety of the care provided to patients in the long-term.

Additionally, most health-care organizations, the survey said, are generally ready to begin testing their health IT systems for the conversion to ICD-10, however most doesn’t have a good sense of how ready they or their partners will be to make the conversion.

The survey results can be found here.

ICD-10 Implementation Not as Costly as FearedHealth Data Management, Greg Goth, June 27, 2014

The cost for physician practices to implement ICD-10 medical diagnosis and in-patient procedure codes may not be anywhere near as high as feared, according to recent data from the American Association of Professional Coders.

According to AAPC’s Rhonda Buckholtz, vice president of education and training, a client analysis has found that “ICD-10 ready” medical practices with fewer than 10 providers have spent approximately $750 per person to prepare for the mandate," as reported in a podcast. "And the cost is even less for practices with 10 to 49 providers. To put this into context, AAPC has trained over 90,000 people toward some piece of ICD-10 implementation, making this cost information all the more compelling."

Results of a separate recent ICD-10 national survey of 349 stakeholders, including 101 clinics/physician practices, found that nearly 42 percent of respondents have spent less than $100,000 on the code transition and almost 15 percent have spent between $100,000 and $500,000 to date. 

However, the one-year delay in the ICD-10 compliance deadline is expected to cost healthcare organizations more money to get ready for the code switchover. When it comes to the additional costs associated with the ICD-10 extension, almost 31 percent of respondents to the survey project that they will spend less than $100,000, while a little more than 12 percent anticipate spending between $100,000 and $500,000 to be ready by October 1, 2015.

Overall, the American Health Information Management Association estimates that another one-year delay of ICD-10 will cost the healthcare industry an additional $1 billion to $6.6 billion on top of the already incurred costs from the previous one-year delay.

Stakeholders Concerned about ICD-10 Implementation, Survey FindsiHealthBeat, Staff, June 27, 2014

Although many health care organizations say they will be ready to begin ICD-10 testing this year, there is widespread concern about ICD-10's effect on workflow, productivity and revenue, according to a survey released Thursday by the American Health Information Management Association, transactions processing management and testing vendor Edifecs and the eHealth Initiative, Health Data Management reports (Slabodkin, Health Data Management, 6/27).

Background on ICD-10U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures. The switch means that health care providers and insurers will have to change out about 14,000 codes for about 69,000 codes.In April, President Obama signed into law legislation (HR 4302) that pushed back the ICD-10 compliance date until at least October 2015.In May, CMS confirmed that HHS plans to soon release an interim final rule that will set the new ICD-10 compliance deadline as Oct. 1, 2015 (iHealthBeat, 6/12).

Survey DetailsFor the survey, researchers polled a variety of industry stakeholders between May and June on the expected effect of the transition to ICD-10 code sets (Edifecs release, 6/26). The survey included 349 respondents, including:

101 clinics or physician practices; and 115 acute care hospitals or integrated health care delivery systems.

Findings on ReadinessThe survey showed that respondents' readiness to begin ICD-10 end-to-end testing varied. It found:

27% of respondents said they were ready for testing in the third quarter of 2014; 14% said they expect to be ready in the fourth quarter of 2014; Nearly 12% expected to begin testing in the first quarter of 2015; About 10% expected to be ready in the second quarter of 2015; 2.5% expected to be ready by the third quarter of 2015; and Slightly more than 10% reported no plans to conduct such testing.

Of those without testing plans, which primarily included physician clinics and practices: 41% said they did not know how to conduct testing; 14% said testing was too costly; 14% said testing was unnecessary; and 6% said their business partners refused to perform testing with them (Health Data Management, 6/27).

Overall, 45% of respondents said they were unsure if their business partners would be ready to begin ICD-10 testing.

However, the survey found that 68% of respondents said they planned to use the additional time before implementation to train more staff, while 31% plan to hire more coders to help with the transition (Edifecs release, 6/26).

Findings on Implementation ConcernsMeanwhile, many respondents raised concerns about integrating ICD-10 codes and their health IT infrastructure, including:

45% who raised concerns about accounting and billing systems;

39% with concerns about electronic health record systems;

37% with concerns analytics software; and 33% with concerns about health information exchange.

Respondents also expressed concerns about ICD-10's effect on revenue. The survey found that: 38% of respondents projected revenue to decrease; 14% of respondents projected a neutral effect on revenue; and 6% of respondents projected revenue to increase.

Overall, respondents thought ICD-10 implementation would make several common activities more difficult in the short-term, including:

Adjudicating reimbursement issues; and Documenting patient encounters.

However, respondents thought ICD-10 implementation would have certain long-term benefits, including: Enhancing research; Improving claims accuracy; Managing population health; and

Measuring performance and quality (Health Data Management, 6/27).

ICD-10 survey indicates ‘surprising’ level of provider readiness FierceHealthIT, Dan Bowman, June 27, 2014

Providers responding to a recent survey on ICD-10 expressed concerns about the impact the coding switch--set to go into effect Oct. 1, 2015, after being delayed in April--will have on revenue, productivity and workflow.

Of 349 providers surveyed between May and June by the American Health Information Management Association and the eHealth Initiative, 38 percent said they think revenue will decrease in the year immediately following the transition; only 6 percent said they think revenue will increase.

Forty percent of respondents, however, said they would be ready to go through with end-to-end testing by the end of this year; 25 percent indicated they would be ready by the end of 2015.

The survey results were made public during a webinar on Thursday.

"I think that what's surprising to everyone is that more people were ready than people actually thought," Denesecia Green, a senior health insurance specialist with the Centers for Medicare & Medicaid Services, said during the webinar. "One of the things we've been talking to groups about doing is how do we ... begin to share some of those best practices and stories of how are they moving forward? ... This survey is very helpful in the sense that it really does validate a lot of the effort and work that has transpired thus far."

Green added that CMS plans to release a "national timeline" to help all ICD-10 stakeholders--from providers to payers to vendors--prepare for the transition. The timeline will consist of particular timeframes in which each stakeholder will need to be ready to test.

Sixty-one percent of respondents said they think that, in the short term, coding patient encounters will be a more difficult task; 44 percent said the same for documenting such encounters. For the long term, however, 41 percent said they think transitioning to ICD-10 will improve claims accuracy, compared to 22 percent who said it will worsen.

Still, providers remain skeptical about ICD-10's impact on reimbursement. Twenty percent believe switching over from ICD-9 will improve reimbursement efficiency, while 33 percent think efficiency will suffer.

Research recently published in the journal Pediatrics determined that the switch to ICD-10 could have a substantial impact on pediatricians' financial bottom lines.

A letter sent to the U.S. Department of Health and Human Services earlier this month by the Workgroup for Electronic Data Interchange presented an ICD-10 transition roadmap to the agency, urging it to ensure Medicare and Medicaid readiness transparency; expedite, support and expand industry testing; expand provider education; and conduct limited pilots.

To learn more:- download the survey results (.pdf)

AHIMA: Revenue, readiness remain among top ICD-10 concernsEHR Intelligence, Jennifer Bresnick, June 27, 2014

Despite the extra year of prep time granted by the ICD-10 delay, a significant number of providers remain worried about how they will meet the demands of the transition to the new code set, now slated for October 1, 2015, and how ICD-10 will impact their practices in the aftermath.  In a survey conducted by AHIMA   and the eHealth Initiative throughout May and June, 38% of providers predicted that their revenue will decrease in the first year after ICD-10, while 26% of organizations have not even conducted a revenue impact assessment.  Widespread concerns over documentation and productivity remain, but providers also appeared eager to begin testing and tackle the hurdles laid out before them.

The 349 respondents, representing a variety of providers, hospitals, and other stakeholders, anticipate some serious short-term problems during the months following the transition.  Sixty-one percent said that coding patient encounters would get harder, while 44% are concerned about difficulties in documenting patient encounters and 41% believe that adjudication of reimbursement claims, including historical analysis of ICD-9 codes, will also pose a problem.  Other barriers to success include interruptions in clinical workflow, productivity, and claims processing, cited by 57% of providers, a lack of adequate staff, change management issues, and the readiness of vendors and partners.

But the respondents were quick to note that these immediate concerns would dissipate as the long-term benefits of ICD-10 became clear.  Four in ten providers think the accuracy of claims will eventually increase, while a quarter think the new codes will have a positive impact on the quality of care and patient safety.  Reimbursement will likely get even more efficient, said 20% of respondents, and a similar number have hope that ICD-10 will foster better payer-provider collaboration.

A majority of providers plan to use the increased specificity of ICD-10 data to help with quality improvement and performance measurement, while 39% anticipate boosting their outcomes measurement and 25% will scrutinize their resource allocation.

While it may be good news for ICD-10 advocates that providers are starting to recognize that the more detailed code set might being improvements to the healthcare system, the path towards those positive outcomes remains rocky and uncertain.  Testing is the big obstacle on everyone’s minds, and they are planning to attack it soon.  Twenty-seven percent of respondents believe they will be ready for testing by the third quarter of 2014, while 14% will be ready by the end of the year.  Only 2.5% will put it off until the end of 2015, but 10% currently have no plans for testing at all.

Of the organizations who don’t have scheduled testing dates, a whopping 41% say it’s because they don’t know what to do.  Others think it will cost too much, and 14% even believe that testing is unnecessary.  The majority of these organizations are physician practices.

For those who are not letting the extra year get them down, despite many anticipating that the costs of the extension might double their expenditures, extra training and practice for coders is first on the list of readiness priorities.  Sixty-eight percent will bulk up their education, while 31% will hire more coders and 29% will invest in computer assisted coding (CAC) technology or other health IT tools to help their staff along as the added time starts to tick away again.

ICD-10 Delay: Organizations Prep For New DeadlineInformationWeek Healthcare, Alison Diana, June 30, 2014

Healthcare organizations are taking advantage of the delay in a variety of ways, such as training more staff, improving documentation integrity, and conducting more robust testing, according to a survey.

In April, Congress and President Obama agreed to delay implementation of the ICD-10standard for medical diagnosis and billing codes to Oct. 1, 2015. A study conducted in May and June found that most healthcare providers are using the 12-month ICD-10 reprieve to prepare for the new coding standard.

The survey of 349 healthcare organizations, vendors, and consultants conducted by eHealth Initiative and the American Health Information Management Association (AHIMA), and sponsored by the health IT vendor Edifecs, found that organizations are taking advantage of the delay in a variety of ways. For example, 61% are using the extension to train more staff; 60% are improving documentation integrity; 47% continue dual coding; and 40% are conducting more robust testing. Only 33% have reallocated resources.

Some observers have questioned the effects of the delay on the healthcare organizations that were working to meet the previous deadline, Oct. 1, 2014. To mitigate productivity loss, 68% of survey respondents plan to conduct extra training and practice, and 31% expect to hire more coders to help with the eventual transition.

By the end of this year, 40% expect to begin end-to-end testing; 25% plan to start this process by the end of 2015. Of the organizations that aren't planning end-to-end testing, 41% claimed no knowledge of how to perform testing.

"If you were training for a marathon and the race was delayed, you probably wouldn't sit on the couch eating potato chips," Lynne Thomas Gordon, CEO of the AHIMA, said in a webinar presentation of the study results. "We are telling everyone to keep the momentum going. Don't stop. Maybe just slow down, but keep the momentum going."

Webinar panel attendees -- including AHIMA and Edifecs executives, plus a representative from the Centers for Medicare and Medicaid Services (CMS) -- cautioned that each ICD-10 delay has multiple effects. Executive buy-in wanes as healthcare organizations lose the sense of immediacy around ICD-10. Students are concerned about the viability of their new skills. And healthcare organizations reallocate ICD-10 funds to new health IT initiatives.

Delays are expensive, too. A one-year ICD-10 delay would increase costs between 11% and 25%, according to 50% of respondents; another 37% fear costs would increase 50% if the coding change were delayed 12 months. A two-year delay would be "potentially catastrophic," 69% of those polled said.

(Source: eHealth Initiative and the American Health Information Management Association)

Denesecia Green, senior health insurance specialist at the CMS, said during the webinar that her agency wants to ensure the coding change continues to advance to avoid increased costs and build on healthcare organizations' ICD-10 adoption progress. For one thing, the delay has already cost her organization; it was fully prepared for an October 2014 rollout of ICD-10 but had to recode systems for ICD-9.

"Part of our effort to align industry and regain that momentum is bringing everyone to the table to develop a national ICD-10 timeline," she said.

The CMS will centrally locate information on partners' ICD-10 testing dates, Green said; it already has 90 partners lined up. The agency also will publicly share partners' information on when they are providing supporting materials, training, webinars, or other informational offerings to healthcare customers. Likewise, it hopes to share best practices to show how many providers are prepared for ICD-10.

"What is surprising maybe to the healthcare industry overall... is that more people were ready than [some] people actually thought," she said. The CMS is talking to stakeholders about how to "share some of those best practices and stories of how they are moving forward, what tools are they using to do that, and sharing them throughout the whole industry. I think this survey... does validate a lot of the effort and work that has happened thus far."

ICD-10 advocates will continue informing healthcare colleagues about the benefits of the next-generation coding system, which was developed in part with physicians, Green said. Executives agreed that the more detailed coding is vital in this age of data, value-based care, and thinner margins.

"I personally view ICD-10 as a natural extension of Meaningful Use," said Deepak Sadagopan, general manager of clinical solutions at Edifecs. "ICD-10 really adds more granularity and reduces ambiguity... Better communication results in better care for the patient, and that's really what this is all about."

Healthcare organizations must do more than test their software, Sadagopan said. System testing is important, but organizations also must optimize workflows, train users, and prepare documentation to ensure success.

Experts agreed that expanding beyond end-to-end testing should help organizations mitigate any expected revenue damage. In the short term, healthcare providers worry ICD-10 implementation could hurt their bottom line. A mere 6% say ICD-10 will increase revenue, whereas 38% fear revenue will decrease, and 14% say revenue will remain flat, the study found. However, 65% plan to leverage the more specific code set for claims processing and billing; 62% expect to use it for quality improvement; and 51% will use ICD-10 improvements for performance measurement.

Where ICD-10 movers are focusing nowMike Miliard, Government Health IT, July 1, 2014

Those healthcare organizations wisely using the extra time for ICD-10 are focusing on clinical documentation improvements, workforce training and partner testing.

That’s according to a recent study by the American Health Information Management Association and eHealth Initiative, which also found that concerns over preparedness and ICD-10’s potential financial impacts are lingering despite the new October 1, 2015 deadline.

Among the tasks widely-anticipated to be tricky after the ICD-10 switch flips, clinical documentation improvement has 61 percent of respondents training more staff in preparation for CDI – alongside the 68 percent holding additional training and practice to mitigate the expected productivity loss. And about one-third of survey participants intend to hire more coders toward that same end.

"Although the mandate has created uncertainties and challenges for all, there is the potential for long-term return in the form of improved claims processing and billing, performance measurement and quality improvement," said Sunny Singh, CEO of Edifecs, which sponsored the survey, in a prepared statement.

While most organizations said they're ready for ICD-10 testing, some are naturally more prepared than others.

Some 40 percent of respondents, for instance, intend to start end-to-end testing by year’s end, while another 25 percent indicated they will begin in 2015. Certainly beginning by the end of 2014 or early next year is in accordance with recommended timelines but the 41 percent who said they do not know how to perform testing and the 45 percent stating they don’t have a good sense of partner’s readiness, could be problematic as the compliance deadline approaches."These results show that 'prime time' for ICD-10 preparedness is now through spring 2015," Singh said. "Testing is vitally important to establish readiness for the ICD-10 transition and to mitigate any potential revenue impacts."

Even if the ICD-10 compliance date is farther away than it once was, it will arrive eventually. (For real, this time. We think.) And while healthcare organizations could be forgiven for taking a foot off the proverbial gas, this is time that should be spent pushing ahead with preparedness plans.

Healthcare organizations use delay to further test ICD-10 readiness Alex DelVecchio, Health IT Exchange, July 2, 2014

The delay of federal ICD-10 implementation gave providers another year, at a minimum, during which they could perform testing to measure their ICD-10 readiness. Fewer than half of respondents to a survey indicated they will start on end-to-end testing this year, with 40% saying they plan to do it before the close of 2014.

An additional 25% replied they would begin end-to-end ICD-10 testing by the end of 2015, according to the survey conducted jointly by the eHealth Initiative and the American Health Information Management Association (AHIMA) and bankrolled by Edifecs, which received responses from vendors, payers, clinic and physician practices and others. Of those with no plans to conduct any ICD-10 testing, 41% said they had no understanding of how to do so. More than a third of respondents (38%) believe that ICD-10 implementation will decrease their revenue, while only 6% think revenue will increase.

“Testing is vitally important to establish readiness for the ICD-10 transition, and to mitigate any potential revenue impacts,” said Edifecs CEO Sunny Singh, in a press release.

The decision to delay ICD-10 until at least Oct. 1 2015 passed the Senate on March 31 and signed into law by President Barack Obama on April 1. Though the delay grants extra time for testing and fixing weak spots in an organization’s ICD-10 readiness plan, there is some speculation that it may be detrimental to those that were prepared for the previous deadline. One such complication is the extra funding needed to support another year of ramping up for the code changeover.

A poll taken at a recent AHIMA ICD-10 Summit found that 88% of those surveyed were disappointed with the decision to delay ICD-10. Respondents were nearly unanimous in their preference for ICD-10 to roll out on one date, with 90% agreeing to that instead of the new codes coming out at separate times for different providers. Half of those polled said they would be interested in reporting their ICD-10 codes beginning on Oct.1, 2014, if provided the opportunity.

Healthcare IT News For VARsMegan Williams, Health IT Outcomes, July 3, 2014

In the news this week, specialty EMR offerings are expanding, and PCs are still dominating EHR viewing platforms.

Survey Reveals ICD-10 Readiness Concerns

Edifecs, eHI, and AHIMA sponsored an ICD-10 preparedness survey last month. The survey revealed that a majority of healthcare organizations are using the deadline extensions to invest in clinical documentation improvements, workforce training, and partner testing. Organizations are still also concerned about readiness and the financial impact of the coding system update. More details are available at IT Business Net.

OmniMD Expanding Specialty EMR Offerings

Despite the growth of EMR, only three vendors gained market share last year. Cerner, Epic, and MediTech were the only vendors to increase their customer base among hospitals, according to a KLAS report.InformationWeek also reports that EMR vendors working with smaller facilities are facing increasingly difficult business development environments because of competition from larger-facility counterparts. Along that same vein, OmniMD plans on expanding their specialty EMR offerings to include at least five new surgery specialties and 14 practice specialties.

Study Finds That Advanced EHR Systems Save Hospitals Money

Researchers from the Medical University of South Carolina used data from 2009 from the National Inpatient Sample and the Health Information And Management Systems Society in a recently released study. The study found that organizations that used advanced EHR systems saved about 10 percent per patient admission when compared to providers that did not use similar systems. More results and implications are available at iHealthBeat.

PCs Still Dominate EHR Viewing Platforms

While mobile device use is growing across the industry, and physicians are increasingly becoming “digital omnivores,” Health IT Outcomes reports that most EHRs are still viewed on PCs. Physicians have actually reported increased use of non-mobile devices. This is most likely explained by the combination of the increase in incentives for using EHRs, and a lack of mobile optimization of EHR tools.

Healthcare IT News For VARsMegan Williams, Health IT Outcomes, July 3, 2014

Healthcare IT Talking Points

In challenge to Larry Page’s claims that Big Data could save 100,000 lives this year through information transparency, FierceHealthIT presents the counter argument from senior lecturer at the School of Computing and Director of Interdisciplinary Cyber Security Centre at University of Kent, Eerke Boiten. Bointen outright argues that the industry has a long way to go, and that costs will not drop until challenges around standards and methods are overcome.

Health IT Analytics reports that 84 percent of financially insecure hospitals are postponing their investment in population health management and clinical analytics infrastructure. The article cites reasons for the decrease in investment as:

Trends in Medicare reimbursement Declining inpatient volumes Rising expenses Bad debt

For more news and insights, visit BSMinfo’s Healthcare IT Resource Center.

ICD-10 Delay: Organizations Prep For New Deadline Staff, Medical Coding News, July 3, 2014

In April, Congress and President Obama agreed to delay implementation of the ICD-10 standard for medical diagnosis and billing codes to Oct. 1, 2015. A study conducted in May and June found that most healthcare providers are using the 12-month ICD-10 reprieve to prepare for the new coding standard.

The survey of 349 healthcare organizations, vendors, and consultants conducted by eHealth Initiative and the American Health Information Management Association (AHIMA), and sponsored by the health IT vendor Edifecs, found that organizations are taking advantage of the delay in a variety of ways. For example, 61% are using the extension to train more staff; 60% are improving documentation integrity; 47% continue dual coding; and 40% are conducting more robust testing. Only 33% have reallocated resources.

Some observers have questioned the effects of the delay on the healthcare organizations that were working to meet the previous deadline, Oct. 1, 2014. To mitigate productivity loss, 68% of survey respondents plan to conduct extra training and practice, and 31% expect to hire more coders to help with the eventual transition.

By the end of this year, 40% expect to begin end-to-end testing; 25% plan to start this process by the end of 2015. Of the organizations that aren’t planning end-to-end testing, 41% claimed no knowledge of how to perform testing.

“If you were training for a marathon and the race was delayed, you probably wouldn’t sit on the couch eating potato chips,” Lynne Thomas Gordon, CEO of the AHIMA, said in a webinar presentation of the study results. “We are telling everyone to keep the momentum going. Don’t stop. Maybe just slow down, but keep the momentum going.”

Webinar panel attendees — including AHIMA and Edifecs executives, plus a representative from the Centers for Medicare and Medicaid Services (CMS) — cautioned that each ICD-10 delay has multiple effects. Executive buy-in wanes as healthcare organizations lose the sense of immediacy around ICD-10. Students are concerned about the viability of their new skills. And healthcare organizations reallocate ICD-10 funds to new health IT initiatives.

Delays are expensive, too. A one-year ICD-10 delay would increase costs between 11% and 25%, according to 50% of respondents; another 37% fear costs would increase 50% if the coding change were delayed 12 months. A two-year delay would be “potentially catastrophic,” 69% of those polled said.

Denesecia Green, senior health insurance specialist at the CMS, said during the webinar that her agency wants to ensure the coding change continues to advance to avoid increased costs and build on healthcare organizations’ ICD-10 adoption progress. For one thing, the delay has already cost her organization; it was fully prepared for an October 2014 rollout of ICD-10 but had to recode systems for ICD-9.

“Part of our effort to align industry and regain that momentum is bringing everyone to the table to develop a national ICD-10 timeline,” she said.

The CMS will centrally locate information on partners’ ICD-10 testing dates, Green said; it already has 90 partners lined up. The agency also will publicly share partners’ information on when they are providing supporting materials, training, webinars, or other informational offerings to healthcare customers. Likewise, it hopes to share best practices to show how many providers are prepared for ICD-10.

“What is surprising maybe to the healthcare industry overall… is that more people were ready than [some] people actually thought,” she said. The CMS is talking to stakeholders about how to “share some of those best practices and stories of how they are moving forward, what tools are they using to do that, and sharing them throughout the whole industry. I think this survey… does validate a lot of the effort and work that has happened thus far.”

ICD-10 advocates will continue informing healthcare colleagues about the benefits of the next-generation coding system, which was developed in part with physicians, Green said. Executives agreed that the more detailed coding is vital in this age of data, value-based care, and thinner margins.

“I personally view ICD-10 as a natural extension of Meaningful Use,” said Deepak Sadagopan, general manager of clinical solutions at Edifecs. “ICD-10 really adds more granularity and reduces ambiguity… Better communication results in better care for the patient, and that’s really what this is all about.”

Healthcare organizations must do more than test their software, Sadagopan said. System testing is important, but organizations also must optimize workflows, train users, and prepare documentation to ensure success.

Experts agreed that expanding beyond end-to-end testing should help organizations mitigate any expected revenue damage. In the short term, healthcare providers worry ICD-10 implementation could hurt their bottom line. A mere 6% say ICD-10 will increase revenue, whereas 38% fear revenue will decrease, and 14% say revenue will remain flat, the study found. However, 65% plan to leverage the more specific code set for claims processing and billing; 62% expect to use it for quality improvement; and 51% will use ICD-10 improvements for performance measurement.

ICD-10 Delay Survey Reveals Concerns Around Economics And Workflow Megan Williams, Business Solutions Magazine, July 14, 2014

Even with the extension of the ICD-10 implementation deadline, some healthcare providers are anxious about the process.

The American Health Information Management Association’s transaction processing management and testing vendor, Edifecs, released a survey that polled industry stakeholders between May and June of 2014 on what effects they expected to see from the transition to ICD-10 code sets.

Survey DetailsThe survey included 349 respondents, of which 101 were clinics or physician practices, and 115 were acute care hospitals or integrated health care delivery systems. Respondents also included vendors, payers, consulting firm representatives, and others.

Key FindingsKey findings of the survey relate to testing plans, potential workflow interruptions, economic impact, training, difficulty of clinical documentation, and code specificity.

Testing Plans. Most organizations are prepared, with 40 percent of respondents indicating that they would begin end-to-end testing by the end of this year. Another 25 percent indicated they would by the end of 2015. For those who reported they had no plans to perform end-to-end testing, 41 percent indicated they did not know how to do so.

Potential Workflow Interruptions. Many healthcare providers are concerned about how the code change will impact workflow, productivity, and revenue. A miniscule 6 percent believe that revenue will increase as a result of the change, while 38 percent believe revenue will decrease, and 14 percent believe it will remain neutral.

Concerns Around Economic Impact. Despite concerns about economic benefit, heathcare providers overall are optimistic that the increased specificity that the code set brings can potentially improve research, population health management, and quality/performance measurement and improvement. At the same time, they answered that common activities including coding patient encounters, adjudicating reimbursement claims, and negotiating contracts between health plans and healthcare providers will likely be more difficult in the short term. Still, in the long-term, the transition is expected to improve metrics like claim accuracy, care quality, and patient safety. Unfortunately, not all organizations have a clear plan to extract value from the transition to the expanded code set.

Opportunity For Additional Training. Healthcare providers also plan to take advantage of the one-year delay to perform additional training — 68  percent plan to conduct additional training and 31 percent have plans to hire additional coders to help with the transition.

More Difficult Clinical Documentation. Clinical documentation is expected to be more difficult. Of all the tasks that change with the upgrade, respondents indicated that they expect the transition to cause problems around clinical documentation, particularly around coding patient encounters. Healthcare providers plan to use the extension to improve the integrity of clinical documentation.

Improved Code Specificity. Lastly, healthcare providers expect to see benefit from leveraging the increased code specificity for claims processing and billing (65 percent), performance measurement (51 percent) and quality improvement (62 percent).