ICD-10 Delay: An Opportunity To Change Course

Easy-to-Mock ICD-10 Diagnosis Codes...

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Congress, an organization that has elevated kick the can to an Olympic-level sport, has decided to delay ICD-10, an initiative that promises to transform healthcare by solving the heretofore unsolvable problem that our billing systems aren't complicated enough.

IT consultants and vendors are acting like my Yorkshire terrier deprived of his favorite plastic bone. The frantic high-pitched barking has made it clear that this delay is the worst thing imaginable. Sunk costs! Unfair to good organizations! Uncertainty! Sky falling, film at 11! About the only complaint we haven't yet heard is that the slightest bad thing is going to happen to patients or providers.

That's probably because it won't. The transition to ICD-10 doesn't change models of payment or introduce new concepts in medicine. It's really just about replacing an old and worn billing code set with one that is more complicated and less understood. An overwhelming majority felt that the best possible short-term outcome from October was going to be no change -- no major hit to revenues, no major confusion, and nobody going out of business. Given the anxiety we've been seeing lately, with federal and state governments demonstrating a distinct lack of success in the IT area, revenues and margins savagely squeezed for provider organizations, and an industry-wide concern about how ICD-10 was really going to work in practice, most of us weren't betting on the best possible outcome.

[Who's complaining? Read ICD-10: Painful To Implement, Painful To Delay.]

ICD-10 is a diagnosis terminology intended for use in fee-for-service medicine. It's designed to capture distinctions that might make payment differences. It doesn't effectively capture prognosis, diagnostic uncertainty, patient choices, planning realities, or anything else that might drive excellent care. Providers will likely treat it as they did ICD-9, minimizing its use except as needed to support revenue. If you think that multiplying the number of billing codes will help, consider that only a small percentage of ICD-9 codes ever appear in a patient record. Complexity for its own sake has already been considered and rejected by the people who produce the data in the first place.

The American Medical Association (AMA) has been firm in its opposition to ICD-10. So have influential individuals within healthcare, at least if you ask them privately and thoughtfully. That opposition was never about whether better documentation and better reporting would help. The question was whether ICD-10, as conceived and implemented, would make meaningful improvements that are worth the cost.

In early 2014, that cost was looming larger and larger. The HealthCare.gov go-live at a minimum highlighted the perilous nature of large government-driven IT projects. Meaningful Use 2 is by itself stressing organizations more than anyone expected in the early days. Timelines are short and IT projects (electronic medical record replacement and upgrades in particular) have slipped. The ICD-10 go-live on Oct. 1, 2014, was clearly an all-or-nothing, life-threatening event that relied on meticulous IT performance and strong organizational focus. And the deadline was drawing near.

(Source: Chris Wimbush - geograph.org.uk

The First Rule of Holes says that when you realize you're in one, stop digging. The ICD-10 hole was growing too large to ignore. So Washington, in a rare fit of sanity, told everyone to put down the shovels.

It's a delay, not a cancellation. We're still in the hole. We're still stuck with too many organizations too dependent on fee-for-service reimbursement. Risk-sharing and accountable care are still really hard to figure out. The people who serve our shared patients -- payers, providers, regulators, and physicians -- still live with historic hostility and regulatory barriers. We can go right back to determinedly digging if we want. In fact, that's still the official plan.

As we lean on the shovel, though, it might make sense that we consider stepping out of the hole. There's no natural law that says we have

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