ICD-10’s five stages of grief

By Hannah Galvin, MD for Healthcare IT News

As ICD-10 draws closer, you may feel like you’re stuck in one of the five stages of grief:

  1. Denial: “ICD-what? Excuse me, I have patients to see.”
  2. Anger: “I don’t have time for ICD-10! The government obviously doesn’t understand the practice of medicine. Why would anyone ever need a code for ‘animal-rider injured in collision with streetcar’??”
  3. Bargaining: “There’s still hope! Physician groups are taking the Hill by storm and I’m confident they’ll be successful because they’re just as frustrated as I am. Another year of ICD-9 it is.”
  4. Depression: “The system is no longer about the patients. I can’t possibly manage the thousands of new codes, while trying to juggle all of the quality reporting metrics. I didn’t go into medicine for this!”
  5. Acceptance: “While some of these codes are just absurd, I do believe it’s important we capture the type of care being given correctly at the point of care. For instance, asthma codes are updated from that ancient ‘extrinsic/intrinsic’ mumbo-jumbo to more appropriate terminology in accordance with NHLBI guidelines. I’m going to make sure my EHR vendor is prepared to help guide me through the process and ensure I’m documenting correctly. Besides, I’ve gotten through challenges before [insert worst residency rotation of your life] – I can get through anything!”

For those of you who have breezed through the first four stages and have come to feel confident with the transition—congrats! But for those of you who are still wading through the process, I’ve got some advice and reassuring thoughts:

To the deniers and bargainers:

This time around, policy experts seem to be in agreement that the ICD-10 transition is necessary to move forward. Proactive outreach by groups in favor of the transition are being heard loud and clear on the Hill, and even previously-vocal opponents, such as the AMA, are now standing down. But politics aside, I think we’re headed in the right direction.

The expanded code set offered by ICD-10 has benefits for physicians across the board, even if it has drastically grown in size. For example, the new set will allow us to accurately track quality measures, which helps us more easily identify high-risk, high-cost patients in need of disease management within our system.

And it’s worth mentioning the majority of the world’s healthcare systems are using the ICD-10 code set. Adopting this set will put us in a better position to share public health data internationally – especially in times when it will have a significant impact such as the 2014 Ebola outbreak.

The more accurately we capture care, the better suited we are to further medical research that will make a lasting impact on our healthcare system. ICD-10 will allow us better use EHR data to more quickly develop clinical advancements and enhance patient care. The level of detail ICD-10 requires will help providers, payers, and government agencies monitor outcomes, analyze costs and resource utilization, and measure performance (including progress on national objectives like injury and violence prevention) – all of which leads to a more coordinated healthcare system.

To the angry and depressed:

I get it – the cost is heinous. A recent study found 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.

At this point, you have already probably invested countless dollars (not to mention hours) into this process; hopefully you’ve been able to tap your technology partner for ICD-10-ready EHR certified services to help assess readiness and train your staff along the way.

No matter how much training you do, the unknown of the transition still remains unnerving. How long will it take to search for a new code? The aforementioned study estimates a 15 percent increase in physician documentation time. To what extent will reimbursement be disrupted? Payer readiness is unclear, and it’s unknown what payers will accept what codes based upon specificity.

No matter where you fall among the five stages spectrum, another ICD-10 delay is only procrastinating the inevitable. Headaches will remain and the cost won’t disappear. In fact, it could have a negative impact on the latter. CMS estimated last year’s delay cost the industry an additional $1 billion to $6.6 billion (not including the lost opportunity costs).

So where do we go from here? We all need to be prepared to meet the rapidly changing industry standards, for ICD-10 and beyond. A few tips:

  • Lean on your EHR vendor and staff to test and anticipate issues. This includes payer interface testing to ensure data that is received is transmitted and accepted seamlessly.
  • Develop an ICD-10 transition team with a dedicated lead.
  • Put in place training plans for clinical and medical billing staff. Note: these should be implemented six months in advance of needing to meet new requirements, but it’s never too late to start if you haven’t!
  • Conduct regular discussion with vendors about readiness and implementation plans. Understand how your vendor will help you ease into the new code set.
  • Set a dedicated budget for the costs and resources needed to complete the transition.
  • Create a financial plan to accommodate for unanticipated cash flow disruptions after October 1.

Providers, let’s move beyond denial and depression to confidently accept the ICD-10 transition come October 1. Partnering with vendors that have services to help minimize workflow disruptions, gaps in patient care, and delayed reimbursement will set you up for success when push comes to shove. Whether you’re ready or not, the transition is less than three months away – and in the end, I believe it will be worth all the grief.

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