An HIM Association Perspective on the ICD-10 Transition

April 9, 2013
When it comes to health information management (HIM) professionals, of course, the Chicago-based American Health Information Management Association (AHIMA) has been deeply and broadly involved in helping its members move forward into the new ICD-10 world.

As the healthcare industry moves forward to prepare for the transition to the ICD-10 coding system, healthcare professional associations are working hard to help their members and member organizations become successful in this area. When it comes to health information management (HIM) professionals, of course, the Chicago-based American Health Information Management Association (AHIMA) has been deeply and broadly involved in helping its members move forward into the new ICD-10 world.

AHIMA has also been tracking the progress of its members and their patient care organizations. In that regard, in late September, the association released the results of a survey, conducted in August, of its membership. In that survey, 85 percent of respondents reported that they had begun work on ICD-10 planning and implementation, up from 62 percent a year earlier. (A majority of respondents were hospital HIM directors, and most of the remainder were associate directors or held similar positions.)

Still, while 80 percent of survey respondents working in inpatient hospitals reported this fall that their organizations had at least begun an impact analysis, only 49 percent had as of August begun making changes based on their assessments.

Reflecting on the results of that survey, and offering her perspectives on the broader issues around the transition Sue Bowman, director of coding, policy, and compliance at AHIMA, spoke recently with HCI Editor-in-Chief Mark Hagland. Below are excerpts from that interview.

When you look at hospital organizations right now, what kind of landscape do you see with regard to ICD-10 preparedness?

The good news is that things have definitely improved, and there’s progress being made. In the first survey we did in April 2010, 55 percent of respondents said they’d begun work on ICD-10 planning and implementation, and in the summer of 2010, 62 percent had begun work. And as of August of this year, the number was 85 percent.

Sue Bowman

How do you view that 85-percent figure? Given the timetable involved, is that good? Bad?

Of course, we would like to see where 100 percent of organizations have at least started. Interestingly enough, when the final rule came out several years ago, and it offered four years’ time to prepare, many people said, oh, OK, I’ll just wait a while. But now of course, it’s only two years away, so it’s no longer far away!

What's your sense of that 85-percent figure in terms of how far people are getting right now?

On the inpatient side, more than a majority seem to have moved beyond just starting; but things are still a bit behind on the non-inpatient side.

What do they need to do on the outpatient side?

Pretty much everything, but there aren’t as many systems involved.

What are the most difficult challenges right now?

I guess right now, the challenge is to be able to find enough internal resources to actually do the work. I hear a lot of jokes about how everything ends up involving the same 10 people who have to lead any initiative in an organization. So the challenge is to find the next 10 people to help you move forward, so you’re not just maxing out that same core group.

In other words, everybody needs to get on board and help. And it seems that a few years ago, everyone was looking at everything regulatory-wise on their plate, and was looking at everything as involving completely unrelated tasks, but actually, these things fit together—meaningful use, EHR implementation, ICD-10; so, if you’re upgrading or buying new EHR systems anyway, why not make sure the new system is ICD-10-compliant?

In other words, do coordinated planning?

Yes, since they do complement and affect each other. And an example of that would be, a lot of people are finding that as they upgrade or change systems, they’re pulling computer-assisted coding products into that technology, and ICD-10 is much more amenable to computer-assisted coding, because of the detail and specificity of the codes. So this will actually help them with their accuracy and productivity for doing ICD-10 coding.

What are the biggest mistakes you’re seeing taking place out in the field?

I guess the biggest mistake is probably waiting too long to get started. People are really going to be scrambling if they wait until late in 2012 to get going on. And we also tell people that the earlier you get started, the more broadly you can spread the cost, so that you’re not trying to cover the entire cost during your 2013 calendar year.

Can you offer a sense of the range of costs involved for the average-sized hospital?

It’s very difficult to come up with easy estimates. Several years ago, the RAND Corporation did a cost-benefit analysis for the National Committee on Vital and Health Statistics. They did a pretty broad range. The problem is that there are so many variables.

I’m hearing that for the average community hospital, it’s costing more than $1 million?

Yes, I’m hearing that, too, but sometimes people are including a range of expenses, including upgrading an EHR system. But I’m hearing it’s even more expensive than for payers. Some payers have more than a thousand different systems that are impacted, that they have to go in and change. And a lot have legacy systems that may simply have to be replaced, which may not be altogether a bad thing, either.

Overall, where are you on the optimism/pessimism spectrum, regarding the industry’s potential for successfully transitioning to ICD-10 on time?

I’m reasonably optimistic. Like everything else with regard to human nature, people move forward to do things as they have to. But the private payers and CMS [the federal Centers for Medicare and Medicaid Services] say they’re right on track. The payer community, I think, is further ahead than the provider community on this.

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