Mass. providers share concerns about ICD-10

FRAMINGHAM, MASS.—The looming shift to ICD-10 is “monumental” and requires collaboration in every aspect, according to speakers at the Massachusetts Health Data Consortium’s Dec. 13 program on the subject. There was a clear sense of urgency if not outright panic from some speakers about the enormity of the transition.

ICD-10 is “incredibly challenging,” said William Fandrich, CIO and senior vice president of IT at Blue Cross Blue Shield of Massachusetts. Several speakers mentioned the problems associated with the move from HIPAA 4010A1 transaction standards to the 5010 standards. Noting that some providers nearly went bankrupt over 5010, which essentially changed a file and was supposed to be the easy, simple part of the overall ICD-10 transformation, Fandrich said that ICD-10 “changes every aspect. It’s difficult to predict how it will all come together because there are lots of conflicts in the system.”

Daniel Nigrin, MD, MS, CIO and senior vice president of information services at Boston Children’s Hospital, described the shift as “probably the biggest challenge we’ve got to surmount. We need to kick off a collaborative effort with more than just talk. We’re at a point where we cannot assume any further delays and now must come up with plans to tackle this. It’s not just a technology or financial project. It involves clinicians at the bedside.”

Studies have shown that although, on average, organizations can expect a three-month coder lag time, that decrease in coder productivity can be mitigated by an increase in ICD-10 practice time. That requires testing data which raises numerous concerns and questions. Fandrich discussed the need to collaborate on testing and for a very structured timeline. Many different use cases already exist--"so many that we could bury payers," said Fandrich. The MHDC is creating governance to help control resources. "We want to lay out a master plan.

"We must collaborate in every area to mitigate risk to the entire system," said Nigrin. "We can’t sit back and hope everything will go well. It’s coming. We must be very purposeful in  testing, set up...all to mitigate risk."

Many payers have created their own maps for the transition but sharing those maps is not just a matter of sharing an Excel file. Denny Brennan, executive director of MHDC, said the organization is working to post and organize all available information on its website, including the development of an "ubermap." There is no shortage of maps, he said. "We have an embarrassment of them. The challenge is in synthesizing them. We will host, manage and disseminate everything related to ICD-10 if the consortium members find it valuable." Fandrich said he believes publishing maps is a good thing because it would "reduce the mystery."

In response to a question from the audience, Fandrich discussed several issues providers should investigate. For one thing, providers should find out their vendors' readiness and where they stand in their vendors' queues. Providers should consider the education, communication and training of staff, especially coders. With the ongoing shortage of qualified coders and the fact that many would rather retire than learn the new system, organizations very well may have to take on new efforts to retain their coders. Myriad education resources exist for coders and Fandrich suggested providers collaborate to supply appropriate ICD-10 training for their physicians.

Collaboration and transparency are essential, said Nigrin. "We don't want to compete on the basis of ICD-10. This is a monumental effort and unless we devote the resources necessary to make it work, we will fail."