July 01, 2013
By Sheri Porter
The clock is ticking on the nation’s implementation of the ICD-10 code set for outpatient diagnosis coding. But new research conducted by the Englewood, Colo.-based Medical Group Management Association(www.mgma.com) (MGMA) found that many physician practices are lagging behind and are concerned about being ready for the Oct. 1, 2014, compliance date.
According to an MGMA press release(www.mgma.com), researchers compiled survey responses from more than 1,200 practices staffed by some 55,000 physicians nationwide. When asked to rate their overall readiness for ICD-10 implementation, only 4.8 percent of responding practices said they had made significant progress toward or were completely ready to implement the new system.
MGMA researchers found that large percentages of practices indicated they were concerned or very concerned about
- overall costs of converting to ICD-10 (81.1 percent),
- changes to clinical documentation (89 percent) and
- loss of clinician productivity after implementation (87.5 percent).
Furthermore, about 89 percent of responders said it would be somewhat difficult or much more difficult to document the patient encounter, and nearly 96 percent were concerned about the ability to choose the right diagnosis code.
- Results of recent research by the Medical Group Management Association found that just 4.8 percent of practices surveyed had made significant progress toward or were completely ready for ICD-10 implementation.
- Physicians’ biggest concerns were the cost of implementation, changes in documentation and loss of productivity.
- A large majority of practices had not heard from health plans or trading partners about plans to test systems prior to implementation, which is a critical step to successfully implement ICD-10.
When it came to testing of claims — a vital piece of assessing ICD-10 readiness — 70.3 percent of practices said they had not yet heard from the major health plans with which they contract regarding a plan’s ability to accept test claims; nearly 60 percent of responders said the same of claims clearinghouses.
The price tag for ICD-10 implementation — particularly for practices covering the costs on their own — also was on survey respondents’ minds. The estimated average cost for a 10-physician practice to upgrade or replace its practice management system and electronic health record (EHR) software was well more than $201,000, said the practices surveyed.
According to the research, many practices could spend significant money to meet their ICD-10 obligations because only 32.5 percent of respondents said their vendors would cover practice management system upgrades or replacement costs. Just 37 percent of practices said their vendors would pay to upgrade or replace existing EHRs.
Putting the Numbers in Perspective
In the press release, MGMA President and CEO Susan Turney, M.D., called the ongoing work associated with the ICD-10 transition “unprecedented.”
“It is proving to be one of the most complex and expensive changes our health care system has faced in decades,” said Turney. She noted that ICD-10 — which increases by fivefold the number of diagnosis codes from which physicians may choose — is set to take effect simultaneously with other federal policy deadlines, including the availability of state health insurance exchanges and implementation of stage two of meaningful use of EHRs.
Other research findings showed that more than 52 percent of survey respondents had not received word from their practice management system vendors as to when software changes necessary to make the transition would be available. Furthermore, nearly 50 percent of practices had not been contacted by their EHR vendors about ICD-10 readiness.
Those numbers are concerning, said Turney, because a successful ICD-10 transition requires coordination among all stakeholders.
“Our data suggest that many practices are in the dark in terms of moving forward with ICD-10, as this coordination has not yet occurred,” said Turney. “Without the necessary software changes and testing, practices will have no confidence that they will be paid for the care they deliver to their patients after Oct. 1, 2014.”
Academy Provides Resources
According to Kent Moore, the AAFP’s senior strategist for physician payment, it is important for family physicians to stay focused and keep their transition teams moving forward because practices not ready for the October 2014 ICD-10 implementation deadline may see practice revenue grind to a halt.
The AAFP is providing resources to help family physicians prepare for the conversion, including a free webinar on ICD-implementation, which was hosted by TransforMED in February. The archived webinar still is available to members via the Delta-Exchange network. AAFP members can join for free to access the webinar. Look for the “Transition to ICD-10” webinar under the “On-demand Webinars” tab in the “Online Seminars” area of the site.
In addition, the AAFP also has created an FAQ document to address the questions and concerns most frequently voiced by members. For example, the document answers questions such as
- Why are we moving to ICD-10?
- What happens if I refuse to use the new code set?
- How should physicians prepare for the transition?
- What type of training will my staff and I need?
- What types of things will I need to include in my documentation?
According to Moore, in addition to the FAQ document, the AAFP also has other resources available, including an ICD-10 timeline to help physicians prepare for the transition to the code set. It includes tips on practice assessment, budgeting, planning, communicating, training, implementation and monitoring.
Another tool calculates how much it will cost(1 page XLS) to implement ICD-10 in individual practices. The Academy also is developing tools to help transition family physicians to ICD-10.
For those who want to learn more, Family Practice Management has published a series of articles on ICD-10, and sessions on ICD-10 will be offered at the AAFP’s Scientific Assembly, scheduled for Sept. 24-28 in San Diego.
“Coding is an integral part of the payment process, so literally, all physicians who bill insurance — either public or private — must learn to use ICD-10,” said Moore. He advised physicians to make use of both AAFP and CMS resources(www.cms.gov) and to stay in close contact with their EHR vendors and trading partners regarding their readiness to test.
“Like much of family medicine, the ICD-10 transition process is a team sport,” said Moore. “All team members — both clinical and nonclinical — must remain active and have a role to play in a successful implementation.”
Related ANN Coverage
Tools for ICD-10 Implementation Available From CMS