The ICD-10 deadline looms in the U.S., but only 28 percent of health providers have performed revenue testing.
ICD-10 is the latest version of the international classification of diseases (ICD) system. Its adoption in the U.S. has been surrounded by considerable controversy even though it was endorsed by the World Health Assembly in 1990 and has been in use by many WHO Member States since.
Indeed, ICD-10 has been around long enough to be a bit long in the tooth now and thus it is scheduled for replacement by ICD-11 in 2017. Yet U.S. providers remain wary of it and many fear a negative revenue impact from its implementation. It’s surprising that this sentiment is so prevalent when only 28 percent of U.S. healthcare providers have actually done revenue impact testing, according to a recent survey.
Qualitest conducted a survey of healthcare providers last month. The quality assurance software testing company polled “over 150 upper-level healthcare industry professionals, mostly in IT positions” on how prepared their organizations are for the upcoming ICD-10 transition. The results were stunningly dismal.
Among the more notable findings from this report and shared with me by a spokesperson are:
- Over 80% of respondents speculated that ICD-10 will “go live” on October 1, 2015. This was of particular note, considering that ICD-10 has been delayed two times already, and many critics gamble that ICD-10 implementation will be deferred yet again.
- Two-thirds of the respondents believe that their revenue will be impacted with the advent of ICD-10. However, only 28 percent have performed any Revenue Impact Testing with their Payers.
- 67 percent of the surveyed providers are relying solely on their clearinghouses to conduct ICD-10 testing. This implies that providers are dependent on their clearinghouses to perform accurate and comprehensive ICD-10 testing, rather than taking responsibility for their own testing.
- Only 28 percent of the providers use automated testing techniques to increase test coverage and improve efficiency and productivity. This is opposed to the 56 percent of respondents who reported that they are solely using manual testing to ensure that their ICD-10 testing will seamlessly integrate in both internal and external systems.
Mankind has become increasingly mobile, making international standards in disease classification and reporting all the more necessary and meaningful in patient care. Further, it makes big data analysis in research better and faster—whether that research is done in one country or many. Standards are essential in properly identifying data for research on collective patient groups, and in assigning research benefits to individuals.
Data reporting standards are crucial to maximizing the potential in precision medicine, a goal the U.S. in particular strives to achieve.
Even so, U.S. providers hesitate, believing the transition may bring financial hardship in some way. Instead of guessing at the outcome, more providers should do revenue impact testing to find out for sure. If the impact is negative, the fault is not in the standard itself but in how well providers are using it, and in how payers are using it or manipulating it. It’s best to discover those issues now and effectively address them than it is to wait and see if fears come true.
Action is always better that inaction or reaction.
Act on ICD-10 testing now and when ICD-11 comes online, respond quickly by testing early and finding the issues that may need addressing before they become a reality.
Once ICD-10 and eventually ICD-11 are in place, then leverage that in your big data projects to further increase efficiencies, improve patient care, and maximize profits.
Delaying new ICD standard adoptions is a fool’s game in the end. Running last in a race has never gotten any runner to the winner’s circle.
The nuviun blog is intended to contribute to discussion and stimulate debate on important issues in global digital health. The views are solely those of the author.