CIOs Are Happy to Hit Snooze on ICD-10

It comes as little surprise that most CIOs believe the decision to postpone ICD-10 was the right move; what is surprising, however, is that an overwhelming majority don’t see the benefits of converting at all, according to the March healthsystemCIO.com SnapSurvey. Specifically, 80 percent said they do not believe the cost-benefit in the ICD-10 switch warrants moving ahead, with some noting that it will have little effect on patient care.

The survey found that most CIOs (72 percent) felt the postponement was a positive for their organization, as it gives them more time to focus on immediate priorities such as Meaningful Use, and helps to relieve some of the pressure brought on by converging deadlines. Those whose organizations were already on course to meet the target, however, believe the extension will complicate planning and budgetary issues and take focus away from the issue. And while 68 percent of CIOs said they believe the industry overall will benefit from the delay, those in opposition feel that strategically it makes more sense to stay on track, and are concerned that the pushback will ultimately hinder their efforts to obtain funding down the road. Interestingly, the vast majority (84 percent) of CIOs plan to keep pushing forward with plans rather than reallocate resources — at least until a firm deadline is established.
(SnapSurveys are answered by the healthsystemCIO.com CIO Advisory Panel. To see a full-size version of all charts, click here. To go directly to a full-size version of any individual chart, click on that chart)

1. Was the postponement of ICD-10 a good thing for you/your shop?
Yes

• While the value proposition of ICD-10 is clear, it is less clear as to whether that value will be realized. This allows us to focus on revenue cycle and clinical initiatives with clear value (e.g., Meaningful use).
• But we really need a new date. If the date slips three to six months, then it is of no help. If it slips two years and strong consideration is given to appropriate application of ICD-11, then this is a good thing.
• We were running out of runway.
• The challenge of achieving full MU compliance on the timeline established by the government is big enough. Postponing ICD-10 by a year or two will give us some breathing room to focus our finite resources, energy, and leadership bandwidth on this ambitious goal — not to mention figuring out how to truly get value out of all this technology we are implementing above and beyond the compliance requirements.
• We hadn’t hired a project director yet, so the timing was good.
• Some of our vendors were behind in getting us releases that were ICD-10 compliant. We had a train wreck approaching in spring 2013 in slamming in dozens of systems for ICD-10 and Meaningful use all at once.
• Takes the immediate pressure off, but we’re not stopping. Much more expensive to stop and restart than to just keep going!
• We were just beginning planning for it in the middle of a huge EMR implementation. It relieved some immediate organizational pressure.
• We’re currently undergoing a HIS roll-out. This allows more time for preparation.
• Doesn’t change our plans or our priorities, but gives us more time to make sure we are ready.
• It allows us to focus on MU.

No

• It will allow our organizations to remove focus from this issue.
• We were all ready geared up for the deadline, actively training staff and making software purchases to be prepared.
• It is actually a null event for us, just like most other government announcements.
• I wish I could have picked ‘not sure’, as the uncertainty of the new date has caused the biggest issues in scheduling and resourcing.
• We have started our ICD-10 program and this delay complicates our planning and budgeting process.

2. Was the postponement of ICD-10 a good thing for the industry in general?
Yes

• The industry has a whole has competing regulatory initiatives and a need to prepare for different payment models. ICD-10 in terms it its overall value is far down the list.
• The benefits of ICD-10 do not seem to be greater than the costs, and in this intense period of MU and new systems, the timing of ICD-10 was bad.
• The truth is that the industry does not require ICD-10 to make major improvements now in patient care, population health, and control cost. Give us a chance to adopt and Meaningfully Use HIT for achieving these aims before forcing us to go to ICD-10.
• Too much too fast — MU, PPACA, and unrealistic EHR implementation timelines would make for a perfect storm.
• I think vendors had fallen behind on preparations.
• Again, hopeful to those who have procrastinated, but probably not much difference if you were already underway.
• Would like to see us skip ICD-10 and wait for ICD-11.
• Yes, it will allow more overall compliance since the compliance rate is related to the speed of sequential expected compliance dates.
• The answer is really yes and no. The initiative is good but the change to physician documentation is going to be monumental and requires a serious extension of technology to be successful.

No

• We are behind and this kind of action keeps us there.
• I think it will make people even more suspect of any other governmental deadlines and will remove all sense of urgency about meeting them, which is fine until they actually hold fast to one, and then we are toast.
• I don’t think the delay will help most of the industry as the smart money will stay on task.
• Because I think it will only allow everyone to delay the inevitable. ARRA Stage 2 vendor programming resource availability could be a significant factor.
• There is NEVER going to be a good time in healthcare to decide when to do this.

3. Will you keep pushing the project forward as if the original deadline was still in effect, or will you now reallocate human and financial ICD-10-focused resources to issues that need immediate attention?
Keep pushing forward

• For now we will keep pushing forward until a definitive new deadline is in place, at which time we will adjust.
• But if we could get a firm date, then we may consider reallocating time to other projects that would have greater benefit.
• We have too much invested to pull the plug midway through. Investments are already made, so they can’t be unmade.
• We want to get this done. Our real dependency is our system vendor and when they will be ready.
• We will continue pushing forward but will adjust our pacing and resource allocation as needed to reflect a more gradual implementation.
• I believe it will be one-year delay.
• A decision has not been made, but we have recognized that to proceed with current plan with the October 13 deadline will increase the overall costs to some degree by at least one year.
• We hope our vendors do to and we can install ICD-10 system upgrades in a more spread out way and not necessarily associated with Stage 2 MU releases.
• Absolutely, we already budgeted for it, now we can have a little more time for compliance.
• We are continuing to move forward but at a slightly less emphatic pace.

4.
 Will it be more difficult to get organizational buy-in again if/when the new deadline approaches?
Yes

• Why should anyone have a sense of urgency about the deadline when it keeps moving?
• Yes it would be, and it still will be as providers will play that card. Not well of course, but they will play it nonetheless.

No

• No, only because it is a regulatory requirement.
• This is SOP for the government.
• Really? Few people in our organization understand and have bought into ICD-10. So it’s a non-issue to have a delay with respect to organizational buy-in.
• If it’s a year no problem but if it’s longer, then priorities will shift.
• Not really, since we are still going to keep moving.
• It’s a requirement which is already in the clinicians’ minds.

5. Overall, do you see a cost/benefit ratio in the ICD-10 conversion that warrants moving ahead?
Yes

• We will have to do it anyway and we have already put time, effort, and resources into it.
• It helps improve comparisons, but while it improves the “granularity” of the data, it is still claims data, and therefore not as useful as the clinical data from EMRs. We should not lose focus of that fact.

No

• In my opinion, the wise move would be to wait for ICD-11 with a 2017-2018 deadline.
• I am not sure there is a positive cost/benefit ratio, but we need to move on.
• Coding is mostly to support billing requirements and governmental interests in healthcare. I see little direct effect on patient care. It’s only after years of peer-reviewed, “evidence-based” research do changes occur at the bedside. In the short-run, all the coding efforts add cost and inhibit workflow.
• No, the case for ICD-10 has not been made. The folks at CHIME and AHIMA claim that we should do it because there is logically some benefit. But what is the value of the benefit? What is the cost to attain the benefit? We must prioritize the benefit of this thing against the myriad of other opportunities. In my opinion, the value of a new coding system is much less than the value of improved exchanges, better clinical systems, or healthcare reform support. We cannot do it all.
• We need to keep this moving. I hope CMS will seriously consider the positions laid out by CHIME.
• No, as it is going to hurt revenues, but we want to get that past us and get on with the new payment reform (not healthcare reform).
• If you look at the big picture, the risks of moving forward aggressively with ICD-10 far outweigh the benefits, in my opinion. Longer term, however, I can see advantages to adopting a more modern way of coding clinical data that outweigh the costs.
• Probably helps bend the cost curve, but I don’t think this is a winner from a reimbursement standpoint. It will help with a more granular analytics capability though.
• The reimbursement penalties are the issue; 40,000 codes seems a bit excessive, and not terribly useful.
• Not if compliance suffers and there is an overall negative effect on a plan to improve healthcare informatics overall.

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