Survey finds majority ready for end-to-end ICD-10 testing

The majority of healthcare organizations are ready to conduct end-to-end ICD-10 testing, according to a survey conducted by the American Health Information Management Association (AHIMA) and eHealth Initiative.

Smaller organizations, however, such as physician practices, appear less equipped to test and are less informed regarding when their business partners will be prepared to conduct testing.

The survey of 454 individuals represented a wide range of healthcare settings including delivery systems, acute care hospitals, clinics and physician practices and sought to gauge readiness for testing and implementation, anticipated financial, clinical, and operational impact, and the strategic implications of an expanded code set. The survey was conducted in May and June 2014.

“As organizations implement the ICD-10 code set, testing is imperative to ensure that trading partners can ultimately accept the ICD-10 coded transactions,” reads an AHIMA/eHI report based on the survey results. “Testing for ICD-10 can be a complex task involving both internal and external resources, as organizations must validate their own workflows around coding and the ability of their trading partners to receive and process transactions. End-to-end testing is an important internal validation tool in which all components of a system are tested in an environment that closely mirrors real-world scenarios.”

According to survey results, 65 percent of respondents could begin end-to-end testing prior to the implementation deadline of Oct. 1, 2015. Of these, a majority (63 percent) will be ready to conduct testing in 2014, while the rest will wait until 2015. Ten percent of all respondents currently have no plans to conduct end-to-end testing, and 17 percent don’t know when their organization will be ready for testing.

“While many organizations are poised to perform internal testing, the external testing picture is cloudier,” according to the report. “Respondents frequently indicated that they are not aware of when their key business partners will be prepared to conduct testing. Respondents were more likely to know when larger partners such as clearinghouses, IT vendors, acute care hospitals and health plans were prepared to conduct testing. More of these larger organizations have also indicated to their partners that they will be prepared for testing in 2014 than smaller organizations such as physician practices.”

The survey showed providers had a mix of concern and optimism about the impact of ICD-10. While 35 percent believed their organization’s revenue would decrease during the first year of ICD-10 use, only six percent thought their revenue would increase—and 14 percent felt ICD-10 would be revenue-neutral. Smaller organizations said they were less ready to mitigate a possible decrease in staff productivity and/or revenue due to ICD-10 implementation.

The majority of providers said they are concerned about the impact of ICD-10 on common clinical and administrative processes, with 59 percent saying coding patient encounters would be more difficult. Smaller practices indicated this would be more difficult than acute care hospitals. Sixty-one percent of clinics and physician practices believed that documenting patient encounters would be harder with ICD-10, compared to 35 percent of acute care hospitals.

When asked about their view of the long-term benefits of ICD-10, the majority of respondents said the new code set would make managing population health and conducting clinical, health services or translational research easier. Organizations plan to leverage the increased specificity of the code set for claims processing and billing (63 percent), quality improvement (63 percent), performance measurement (52 percent) and outcome measurement (41 percent).

“Compared to data from a similar survey in 2013, the percentage of respondents planning to use ICD-10 for quality improvement, performance measurement and outcomes measurement has increased, suggesting that organizations may better recognize the potential benefits of ICD-10 as they grow more familiar with the code set,” the report said.

More respondents believe ICD-10 will make managing population health and conducting clinical, health services or translational research easier rather than harder. They also believe that ICD-10 will ultimately improve the accuracy of claims (41 percent), quality of care (29 percent) and patient safety (27 percent).

The two organizations included in their report advice on further preparation for the implementation deadline:

• Test early and frequently. Testing should take place at all stages of implementation, not only in an end-to-end environment. Stakeholders should test systems as they work with their vendors to make upgrades and communicate with all of the individuals involved to ensure the system functions properly.
• Collaborate. Stakeholders should reach out to peers and other organizations in their region to share best practices for ICD-10 implementation.
• Mitigate risk prior to implementation. Strategies such as dual coding can help organizations mitigate the risk of ICD-10 implementation by familiarizing staff with the new code set in advance, thus improving coding accuracy and productivity.