CHI CIO Michael O'Rourke: How the ICD-10 Delay Impacts Hospitals

For many within healthcare, ICD-10 is treated as a sleeping giant: Tread gently around it, so as not to wake it. HHS and CMS recently proposed a rule to delay the compliance date of ICD-10 from Oct. 1, 2013, to Oct. 1, 2014, but what do hospitals and other healthcare organizations think of the delay?

The American Hospital Association submitted comments to CMS Acting Administrator Marilyn Tavenner in May, saying it supported the one-year delay, but CMS should finalize a course of action soon. The American Medical Association, which represents physicians who are generally seen as a group who would struggle more with the associated costs of ICD-10, went one step further, suggesting CMS have a two-year delay to 2015 "at a minimum."

As of February, only 41.8 percent of hospitals have completed an ICD-10 implementation plan, according to a survey from the AHA. However, many hospitals, health systems and other groups are well ahead of the game and have already spent the millions of dollars to ensure their coding, documentation and subsequent revenue stream do not run into any major hiccups.

Michael O'Rourke, senior vice president and CIO of Catholic Health Initiatives in Englewood, Colo., gives his take on the ICD-10 situation, which is expected to be finalized from CMS during the course of the summer, and the overall influx of health information and revenue cycle initiatives.

Michael O'Rourke is CIO of Catholic Health Initiatives.Michael O'Rourke, senior vice president and CIO of Catholic Health Initiatives (Englewood, Colo.): At Catholic Health Initiatives, our position is that we should delay the implementation of ICD-10 by at least a year — and, preferably, two years. Here's why: We are engaged right now in a huge [health IT initiative] and the need to put this in all of our ambulatory records across 76 hospitals, 2,000-plus employed physicians and 6,000-plus affiliated physicians. Added to that are health information exchanges, as well as meaningful use deadlines, which have very restrictive deadlines. So these alone are major undertakings.

Now, add right into the middle of that the requirements of ICD-10, and you have a very daunting situation. ICD-10 will have a huge impact on organizations, not only in terms of the increase in the number of codes. This is going to require a tremendous amount of retraining and training for coders. That in itself is a massive and costly endeavor in the middle of everything else. You can't make mistakes on this. And beyond the training of coders, this also has to be incorporated into clinical documentation for physicians. They have to be familiar with it.

Another consideration is that we're still working through [Version] 5010, the regulatory requirements by CMS to change claims forms and processing. It was a disaster — not our disaster, but a disaster for CMS. They weren't ready to take the forms, and they couldn't filter out the information. We could not collect many millions of dollars in reimbursements because they couldn't process the forms. That was a lesson about going out with something this complicated too soon. It could be apocalyptic.

That is not to say that we object to ICD-10. There are huge opportunities for organizations to incorporate these codes and to be more precise. There is more opportunity to get it right, to be more specific. We know it's the right way to go. It's just a matter of the timing.

What are your thoughts on the ICD-10 delay and ICD-10 in general? Email your comments to Bob Herman at bherman@beckershealthcare.com to be used in a future story.


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