MGMA research indicates industry ICD-10 readiness lagging

Association calls on practice trading partners to release implementation plans

MGMA research released yesterday suggests that the overall readiness of the industry to meet the Oct. 1, 2014, compliance date to adopt the International Classification of Diseases, Tenth Revision (ICD-10) continues to be slow. The greatest concern is the lack of communication and critical coordination between physician practices and their essential trading partners (such as claims clearinghouses, electronic health record (EHR) vendors and practice management system vendors) regarding software updates and testing, which has not yet occurred. Only 4.8 percent of practices reported that they have made significant progress when rating their overall readiness for ICD-10 implementation. The research includes responses from more than 1,200 medical groups where more than 55,000 physicians practice.

“The transition to ICD-10, with its substantial impact on documentation of clinical care, physician productivity and practice reimbursement, is unprecedented,” stated Susan L. Turney, MD, MS, FACMPE, FACP, MGMA president and CEO. “It is proving to be one of the most complex and expensive changes our healthcare system has faced in decades. Adding to the implementation challenge and clearly taxing all stakeholders, ICD-10 will arrive at the same time that a number of other transformative federal policies go into effect, such as health insurance exchanges and Stage 2 of the CMS Meaningful Use EHR Incentive Program.”

“A successful transition to ICD-10 requires coordination between providers and their vendor, clearinghouse and health plan trading partners. 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. In order to prevent disruption to the nation’s healthcare system, we call on vendors, clearinghouses and health plans to immediately release their implementation and testing schedules.”

Research findings

• Lack of response from vendors. More than 52 percent of respondents indicated they had not heard from their practice management system vendor regarding when software changes would be available to the practice. Almost 50 percent had not heard from their EHR vendor.
• Internal software testing lags. Only 5.9 percent of respondents reported that internal software testing has begun or is complete with their practice management software vendor and 4.7 percent with their EHR vendor.
• External testing delays. Just 11.9 percent of respondents reported that external testing with their clearinghouse has started or is complete. Almost 60 percent reported that they have not even heard from their clearinghouse regarding a testing date. Only 8.6 percent have started or have completed testing with their major health plans, with a concerning 70 percent stating that they have not heard from their major health plans.
• Low confidence for a successful transition. Nearly 60 percent of respondents stated they are “slightly” or “not at all confident” that their major health plans will be ready to meet the Oct.1, 2014, compliance date.
• Concern about changes to clinical documentation. Among a number of implementation concerns, 88 percent are concerned or very concerned about the expected changes to clinical documentation; 87.5 percent are concerned or very concerned about the loss of clinician productivity after implementation; and 81.1 percent of respondents indicated they are concerned or very concerned with the overall cost of switching to ICD-10.
• Absorbing costs for transition. Only 32.5 percent of respondents report that their cost to upgrade or replace their practice management system software will be covered by their vendor. Only 37 percent say their vendor will cover the cost to upgrade/replace their EHR.
• Cost of transition. For those organizations that must cover the costs themselves, the average cost for a 10-physician practice to upgrade or replace their practice management system and EHR software to accommodate ICD-10 is $201,690.

The Centers for Medicare & Medicaid Services (CMS) has mandated the ICD-10 diagnosis code set for use by physician practices, other providers, clearinghouses and health plans. The healthcare industry uses the ICD code set, developed by the World Health Organization, to identify patients’ diseases, signs, symptoms, abnormal findings, complaints and causes of injury or diseases. With ICD-10 containing more than five times the number of codes as ICD-9 and incorporating a completely different structure, the new code set will require extensive changes for medical groups.