Five Reasons Physicians Are Resisting ICD-10 Implementation
(Editor's Note: This guest blog was written by Massoud Alibakhsh, president and CEO of Nuesoft Technologies Inc., Marietta, Ga.)
Although ICD-10 finally has an official deadline, many physicians remain concerned about the impact the new coding system could have on their practices. Nuesoft has compiled a summary listing five of the top concerns expressed by our physician clients.
1. Deadline Seemed Like a Moving Target
The original ICD-10 compliance deadline was Oct. 1, 2011. That date was pushed back to Oct. 1, 2013, after a number of healthcare organizations expressed concern that many physicians, hospitals, and billers would not be prepared for the transition. In April 2012, the Department of Health and Human Services (HHS) proposed another delay. Physicians waited another five months for an official ruling that delayed the implementation and set Oct. 1, 2014, as the official deadline for compliance. While HHS has stated that this is the final delay, many physicians are still concerned that there is a chance, albeit a small one, that this date could be delayed yet again.
2. Added Strain on Resources
ICD-10 contains nearly five times as many codes as ICD-9. Some physicians believe that their coding staff will experience an increased burden as they try to learn a new set of codes. Training will take more time away from current responsibilities, and some estimates indicate that coders may need 50 hours of training or more to become familiar with the new code set. In addition, staff productivity is a concern for physicians. According to reports published by the American Health Information Management Association (AHIMA), one month after conversion to ICD-10, coders in Canada were coding at rates nearly 50 percent of what they were prior to conversion. After one year, that rate increased to 80 percent - though still not back to previous levels.
3. Increased Costs
Physicians also are concerned about the added costs associated with transitioning to ICD-10. Practices may need to hire additional staff to keep productivity levels consistent with ICD-9 coding during the transition period. Most practices also will need to provide ICD-10 training for their coding staff, and additional IT costs may be incurred. Physicians who have already implemented EHR software may be required to upgrade their equipment and/or software, which could be costly as well. According to a study by Nachimson Advisors, the estimated cost impact of the ICD-10 mandate for a typical small practice is $83,290.That amount increases to $285,195 for medium practices and $2.7 million for large practices.
4. Reimbursements Could Be Negatively Affected
While ICD-10 aims to help increase reimbursement with fewer rejected claims and better efficiency in the billing process, many physicians are worried that it will have the opposite result, particularly in the early stages of the transition. The new complex code set has the potential to confuse staff into entering the wrong codes for certain diagnoses, adversely affecting reimbursements by generating more claims rejections.The learning curve is steep, and practices could experience a greater number of rejections during early integration; however, rejections should decrease as coders become more familiar with the new code set. With added expenses associated with ICD-10 implementation, claims rejections are the last thing a practice needs.
5. Fear of the Unknown
It's natural for people to be apprehensive about change. ICD-9 codes have been in use in the U.S. for more than three decades - longer than many physicians have been practicing medicine. A number of physicians do not believe there is a need for change. As the saying goes, "If it isn't broken, don't fix it."
This major change comes on the heels of the costly transition to ANSI 5010, which many physicians believe has adversely impacted the reimbursement process, with no significant benefits to date. In fact, the added cost of operations brought about by regulations and mandatory automation makes for a much more challenging landscape, especially for smaller physician offices in primary care or in rural areas. If this trend continues, the quality and cost of care throughout the country will be affected.
The Institute of Medicine, an independent, nonprofit organization that serves as the health arm of the National Academy of Science, issued a September 2012 report that found the health care system wastes $190 billion per year on paperwork and other unnecessary administrative costs. Studies such as this one underscores the need for a strong and comprehensive framework that cuts costs and applies to all parties responsible for healthcare reimbursement.
Short of a real and meaningful solution to this fundamental issue, our healthcare system will continue to be plagued by piecemeal implementation of so-called standards - "Animal Farm"-style.