i cd 10 summit takeaways

7/31/2019 i CD 10 Summit Takeaways

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Ediecs, Inc

Key Takeaways from

the 2012 ICD-10 Summit

A Compilation of Prevailing Wisdom,

Lessons Learned, andof Coursethe

Concerns Over a Potential Delay

Publication Date: March 12, 2012

Special Report:


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Audience Poll

Yes No Uncertain

Within 3 years, do you believe that ICD-10

will drive down healthcare costs for your

organization?

42.9 %34.7 %

22.4 %

Chie Executive Ocer/Chie Operations Ocer

Chie Financial Ocer

Chie Inormation Ocer

All o the above

Other

Who is Sponsoring your ICD-10 effort?

23.9 %

2.2 %

8.7 %

13 %

52.5 %

Less than $10M More than 30M

11M20M Dont know

20M30M

What is your overall ICD-10 budget?

16.9 % 18.5 %

33.8 % 16.9 %

13.8 %

Key Takeaway #1:

The Value of ICD-10 (a.k.a. Why are we doing this?)

There is much to debate about ICD-10, including the required time and cost investments an

how it will ultimately help the industry deliver better care. Ater all, any large undertaking in

healthcare should have a meaningul impact to the system itsel.

The prevailing sentiment among Summit attendees is that while the migration to ICD-10 m

be painul, it is an important stepping-stone to getting a better grasp on runaway costs and

leveraging more granular data in support of Meaningful Use and quality measures.

Regardless o the nal decision on whether to delay the ICD-10 compliance deadline (at the

time o this report, HHS had not issued a nal decision), Summit participants expressed stron

support or ICD-10, and this was echoed by a CMS representative during the nal keynote

presentation. All believe ICD-10 will bring value to patients, providers and payers.

The key to great healthcare is in the data. The promise o ICD-10 is that the data the industry

previously couldnt collect at a granular-enough level will now be available and help take th

industry to a higher level o care.

In 2004, the RAND Corporation, in a report titled The Costs and Benefts o Moving to ICD-10 Code

Sets1, quantied some of the benets of improved data derived from ICD-10. RAND conclude

that the benets ar outweigh the costs o implementation, estimating the dollar value o th

benets in the ollowing categories:

More accurate payment for new procedures

Fewer rejected claims

Fewer fraudulent claims

Better understanding of new procedures

Improved disease management

Though the frequently cited RAND report is several years old, many in the industry still cite its nd

and the benets it outlines. At the ICD-10 Summit, CMS urther expanded upon these point

Better analysis of disease patterns and treatment outcomes this will help the industry

better track public health risks, identiy trends and share best practices o care

Specicity and accuracy of health data this forms the foundation for eective

research and supports disease management and decision support tools Robust categories to support quality measurement eorts this will better inform

policy decisions to improve health outcomes

While time will tell who actually will benet from ICD-10 and to what degree, the various

Summit presenters, including CMS, broke it down in more detail throughout the two days.

Value to Payers: An overarching goal or many health plans is to ensure they and the memb

they cover are paying the right amount or the right care, delivered at the right time. ICD-10

deliver on this goal via:

Improved administrative eciencies only one in ve medical claims are paid without requ

or additional inormation. According to the nal rule or ICD-10 published by HHS in 20

a reduction in rejected claims as a result o ICD-10 could save the industry $578 million

Enablement of more precise rate setting for medical services Better support for comparative eectiveness research to identify best practices and info

standards o care

Support for Aordable Care Act (ACA) initiatives, particularly in the areas of fraud, waste

and abuse

Support for the move from the current volume-based healthcare delivery system to a

value-based purchasing system that focuses on quality of care and health outcomes ve

the volume o patients and procedures

1RAND Corporation. The Costs and Benefts o Moving to ICD-10 Code Sets. March 2004.2U.S. Department o Health and Human Services. Federal Register, Vol. 74, No. 11. HIPAA Administrative Simplif

tion: Modifcations to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS. January 16, 2009.

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Yes No Uncertain

For those companies targeting

neutrality, have you framed/dened

your neutrality process?

16 %

51 %

33 %

Yes No Uncertain

Will ICD-10 granularity support

improvements to quality efforts that

are designed to improve outcomes?

83.6 %

14.6 %1.8 %

Audience Poll Value to Healthcare Consumers: Patients want to trust that their providers and insurancecompanies are providing the best medical decisions and treatments at the right cost. They a

seek to have care tailored to their specic condition (known as personalized medicine) to

ensure optimal treatment. ICD-10 can help achieve these goals as well, because:

ICD codes drive clinical decision support software. When coupled with the use of

electronic medical records and healthcare inormation exchanges, patients can avoid

undergoing and paying or re-diagnosing or re-testing, unless there is a demonstrable

need. The black hole o inormation will no longer exist In healthcare, specicity and accuracy matter. Accurate data and better technology

will save lives

More detailed data and clinical evidence can drive development of more targeted,

powerul and robust disease management protocols

Value to Providers: ICD-10 will ease meeting other healthcare mandates, including

requirements for Meaningful Use, because it enables more expansive and granular reporting

o medical diagnosis and inpatient procedures. Because ICD-10 promises to yield more

specic data, tying it to EHRs now, rather than later, is benecial to payers, providers, and

patients. More specic data can be more eectively analyzed to create better health

outcomes, or example:

A huge concern is how to classify the patient who fails to follow a recommended

regimen o care and gets sicker as a result. ICD-9 has only one code or patient

non-compliance. However, in ICD-10, there are at least eight, including Intentional

under-dosing due to nancial hardship and Unintentional under-dosing due to

age-related debility. By documenting a more specic reason or non-compliance,

providers can tailor ollow-up care to improve the patients health outcome

ICD-10 will also help reduce time spent on rejected claims (as well as time needed

to request and process additional supporting clinical documentation). The ICD-10

codes already provide more detailed inormation than ICD-9 codes, and using them

appropriately will reduce the need to recode claims

Key Takeaway #2:

Financial Neutrality is Top of Mind and Hard to AchieveFinancial Neutrality was a priority topic at the ICD-10 Summit, and attendees engaged in a

healthy dialogue with presenters regarding strategies or realizing the objective. Several

presenters mentioned the potential or negative cash fow throughout the ICD-10 transition

cautioning attendees to anticipate hiccups and to plan or nancial imbalance or a period o

no less than six months.

While most of the conversation centered on how to achieve neutrality, the Summit also

unearthed a collective perspective on perceived barriers, realistic expectations and challenges

around the initiative. Most stem rom communication breakdowns and disagreement on

exactly how to dene neutrality across multiple dimensions.

Blue Cross Blue Shield o Michigans (BCBSM) Roadmap to Achieve Neutrality

Moving rom ICD-9 to the ICD-10 code set isnt an exact science. A payer can test and emulaclaims based on what they expect to receive, but they cannot accurately mimic an actual cl

submission. Conversely, a provider will know what ICD-10 code to submit, but will not know

how a payer will respond to that code or reimbursement. Every trading partner will ace th

conundrum as it works through the code conversion. In his presentation, Dennis Winkler o

Blue Cross Blue Shield o Michigan emphasized that only when trading parties come toget

can they collectively develop a roadmap to achieve nancial neutrality.

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At the claim level

At the individual provider/acility

At a legal entity level At a logical grouping o providers/acilities

At the geographical location/area level

At the payer level

No idea

None o the above

At what level of granularity will you

measure neutrality?

23.6 %

7.9 %

5 %

7.1 %

10.7 %

15 %

19.3 %

11.4 %

1 Dimension 6-7 Dimensions

2-3 Dimensions 8-9 Dimensions

4-5 Dimensions > 9 Dimensions

For those companies targeting neutrality,

how many unique dimensions have you

targeted/identied?

32.9 %

55.7 %

5.1 %

20 %

32 %

12 %

22 %20 %

8 %

6 %

Audience Poll Getting Started Identiying Core ICD-10 Work Streams

Winkler highlighted there are several work streams that should be addressed during implementat

Assessing the technical and business impacts of ICD-10

Creating and applying payer-specic ICD maps

Executing complete and thorough testing

Training and communicating with all stakeholders, and

Establishing post-implementation monitoring and alarm triggers.

He also stressed that determining the operational status quo was instrumental in achieving neutra

Dening Specic Dimensions o Neutrality

From a payer perspective, neutrality means maintaining current claims acceptance rates, the

number and rate of inquiries, the rate of electronic claims, and claims reimbursement amou

(which is central to nancial neutrality).

However, the industry has struggled to dene specic dimensions o neutrality that can serv

as a oundation rom which to build models, predict outcomes and then work with trading

partners to test and analyze those predicted outcomes.

BCBSM has worked to maintain its operational status quo, however, by targeting six key

dimensions o neutrality:

Payment (Provider): Neutrality is based on identifying shifts of DRG payments and work

to minimize their eect

Benet (Member): Neutrality is based on no expansion or reduction in benets or

out-o-pocket costs as a result o the ICD-10 implementation

Revenue (Payer): Neutrality is based on no signicant increase or decrease in reimbursem

Clinical (Programs): Neutrality is based on having approximately the same number of

candidates in their wellness and care management programs that they have today

Operational (Servicing): Neutrality is based on a lack of increase in BCBSMs key performa

metrics, such as rst pass, pend rate, etc.

Financial (Overall): Financial neutrality refers to the cumulative eect of the variance in t

previous neutrality dimensions. Acceptable levels o variance across other dimensions co

result in an unacceptable overall variance. Extensive statistical modeling will be required

address this dimension

Because interruptions to payment models would have potentially negative repercussions o

provider relationships, BCBSM worked to dene the business stratications o payment neutra

and acceptable ranges or being considered payment neutral. His team also developed a

baseline or BCBSMs existing book o business using dened business stratications, identi

and anticipated payment dierences with conversion to ICD-10 and modied criteria in orde

to categorize anticipated payouts within acceptable ranges.

Using Data to Anticipate Payment Diferences

In doing so, his team developed three steps or identiying anticipated payment dierences

Creating ICD-10-based equivalent claims using a third party tool for claims creation and

using historical data

Manually re-coding ICD-10 claims to document probable DRG shifts

Asking external providers to re-code targeted ICD-10 claims from existing medical recor

The last step is critical because it leverages partners to help identiy high-risk, high-sensitivit

claims and demonstrates which claims are likely to be submitted. It helps both parties agree

the denition o neutrality. Payers can then better understand the inormation that provider

will likely send when using ICD-10 code sets, and providers can identiy gaps in medical reco

documentation standards. This is the key to testing and proong concepts that help payers

evaluate and validate payment neutrality with their partners.

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Budget

Training

Payer or provider partner readiness

Vendor readiness

Executive commitment

What do you believe is your

greatest exposure?

48.6 %

18.6 %

15.7 %

8.6 %

8.6 %

On-going solid communication plan

Communication plan but no ongoing dialogue

Occasional contact

What communications?

How do you view the strength ofcommunication channels between

external partners and your organization

regarding ICD-10?

29.5 %

33.3 %

33.3 %

3.9 %

Which external trading partners are likely

to present the greatest challenges to the

success of external testing?

Physicians Government authorities

Hospitals Sotware vendors

Clearing houses Payers

25.4 %16.8 %

5.3 %

20.6 %

12.9 %

19.1 %

Audience Poll Key Takeaway #3:

Collaboration among Trading Partners is Central to Success

The ICD-10 Summit unveiled shared sentiment among payers and providers around the

importance o partner collaboration throughout the ICD-10 migration. One session ocused

exclusively on this topic and eatured Cleveland Clinic and Medical Mutual o Ohio as co-presen

Together the two speakers equipped the audience with lessons learned, as well as best and

next practices or approaching ICD-10 as a shared initiative.

Attendees and presenters alike discussed the need or prioritizing clinical documentation,

preauthorization procedures and coding policies because they aect business operations

and the ability to achieve nancial neutrality.

While it is clear that specic ICD-10 transition activities will vary tremendously across organizat

and between payers and providers, the ICD-10 Summit unearthed a dialogue that placed

tremendous signicance on developing strong relationships. Collaboration or successul ICD

includes sharing detailed knowledge o internal workfows, increasing transparency to creat

trust, and undertaking a concerted eort to oster the good will necessary to tackle a projec

the magnitude o ICD-10 successully.

Lessons Learned rom Cleveland Clinic and Medical Mutual a Collaboration Case Stu

Cleveland Clinic has held true to its mission since its ounding in 1921 to provide compassion

healthcare of the highest quality in a setting of education and research. As the organizationprepares or its conversion to ICD-10, it is applying a disciplined technology-, training- and

collaboration-based approach that emphasizes provider and payer education, detailed knowled

sharing and a careul project management structure.

A Joint Discovery Mission

Cleveland Clinic identied its largest trading partner, Medical Mutual o Ohio, as one o its ke

ICD-10 partners. The two organizations agreed to embark on a discovery mission together

gain a collective understanding or how both companies processes worked and how ICD-1

would aect each o them. This shared knowledge was instrumental in helping the two

organizations set expectations, dene work requirements and commit to project sign o

obligationsthe elements necessary or successul migration.

One o the key eorts was to work together on the technology and process changes that wodisrupt clinical documentation and coding, patient nancial services and clinical research an

physician unctions. The companies objectives were to evaluate the way the organizations

currently used ICD-9 codes and to identiy specic gaps in clinical and business operational

readiness regarding the implementation o the new ICD-10 code set.

A Common Project Plan and Joint Testing Matrix

Cleveland Clinic mapped out two ICD-10 project budget proposals spanning the course

o three years; one refected an aggressive approach, while the other was more conservative

and actored in higher health inormation management and billers costs or the 2013 and

2014 nancial years. The dierence between the two was more than $7 million dollars.

Through revenue cycle training, strong clinical documentation, physician integration and

technology advancements, Cleveland Clinic sought to reduce its budget targets.More importantly, Cleveland Clinic knew that strong cooperation with Medical Mutual regar

ing nance, reimbursement and contracting strategies would be instrumental in lowering

costs. The two companies resolved to dene and set project priorities that would involve

key business and IT personnel as appropriate and then share them as a framework for

creating a joint roadmap.

The companies worked together to develop the project plan, including a crosswalk approac

or bi-directional ICD-9 and ICD-10 mapping. Their joint strategy also called or an ICD-10

crosswalk analytics tool to simulate and assess the potential revenue impact on both sides.

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Yes No Uncertain

Do you believe your organization has

budgeted appropriately for ICD-10 testing?

36.6 %

16.9 %

46.5 %

Yes No

Do you plan to do specic testing

based on claims scenarios specic

to the policy intent?

75.7 %

24.3 %

What are (or will be) the most signicant

challenges to your organizationssuccessful achievement of the ICD-10

conversion testing process?

Sta resources

Technical expertise

Coordination among business units/ unctions

Coordination with external trading partners

Platorm or sotware complexity

Vendor preparedness

Provider preparedness

Data or data standards

Testing inrastructure

17.8 %12.7 %5.1 %

5.1 %

4.4 %

12.4 %

16 %

15.3 %

11.3 %

Audience Poll Ongoing Communication and the Power o Goodwill

The other critical piece o the Cleveland Clinic / Medical Mutual o Ohio was something that

attendees heard repeatedly throughout the Summit: ongoing communication. Due to Clevel

Clinics size and volume o claims, the two organizations knew they would need to test near

every scenario. Both organizations have consistently worked to communicate their readines

accept new code sets and keep the process moving orward.

Through joint discovery, transparent communication, and sharing ICD-10 project test results

analyses, Cleveland Clinic and Medical Mutual o Ohio have determined their best practices gaining ICD-10 project momentum. They have also determined how to apply lessons learne

rom their successul collaboration on other mandates and healthcare initiatives, like HIPAA 50

The joint eort and approach they shared at the Summit is already accelerating their ICD-10 e

and has put Cleveland Clinic on pace to save more than $7 million in implementation costs.

Key Takeaway #4:

Risk-Based Testing is Critical

The announcement that CMS will delay the implementation deadline or ICD-10 adds more

uncertainty to the already-conusing nal phases o payer ICD-10 projects. For many payers,

the remaining project phases will ocus on testing ICD-10 migration solutions. According to

Summit presentation by Janice Young o IDC Health Insights, most payers will be heavilyinvolved in ICD-10 system testing by mid-2012; and other orms o testing such as regression

user acceptance,

perormance and comparison testing by late 2012. She based her assessment on results o a

IDC Health Insights survey o payers and released those results at the ICD-10 Summit.

While health plans are moving quickly into these testing phases, major questions remain

unanswered about how to approach testing, given the pervasiveness o ICD-10 impact acro

healthcare enterprises.

Blue Cross Blue Shield o Michigan and Humana are ocusing testing on

business neutrality goals

Dennis Winkler from Blue Cross Blue Shield of Michigan, emphasized that testing should focus

maintaining the operational status quo. This means keeping the business neutral with respeckey performance indicators such as claims acceptance rates, support inquiries, electronic cla

adjudication rates and aggregate claim reimbursement amounts.

He suggested that neutrality testing begin with a systematic approach to internally creating

ICD-10 test claims, including the use o certied coders to create claims rom existing medic

records. These claims should refect high-risk scenarios aecting payments, benets, revenu

clinical programs (wellness and care management) and operations. Blue Cross Blue Shield o

Michigan is creating internal test data targeted at testing this processes. However, the ultima

goal is to obtain test claims rom external trading partners who have created ICD-10 claims

rom existing medical records.

In his Summit presentation, Sid Hebert o Humana explained the process Humana is using to

develop their internal testing data. He emphasized that payers must develop test scenarios t

refect use o high-risk codes, specically claims that use codes expected to have high volumor high dollar values. Humana analyzed historical claims to identiy their high-risk scenarios.

Like any enterprise technology project, the time allocated to testing or ICD-10 is nite, while

the code-mapping permutations created by ICD-10 are not. As Humana has learned, the key

to minimize the risk to the business by ocusing eort on testing scenarios that could have t

most impact. By doing this Humana was able to reduce the number o ICD-10 testing scena

rom several hundred thousand to just a couple o hundred.

Payers and Providers agree on the necessity o a collaborative testing efort

Several presentations at the ICD-10 Summit ocused on how to start collaborative testing betw

payers and providers. Lyman Sornberger o the Cleveland Clinic and Annette Melda o Medi

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Core system replacement

Resource availability

End-to-end testing

External partner readiness

Budgetary constraints

Of these areas, what is your

organizations biggest challenge

or area of concern today?

25.8 %

9.1 % 9.1 %

16.7 %

39.4 %

Yes No

Have you developed measures to evaluate

the business impact of policies?

68.3 %

31.7 %

Audience Poll Mutual o Ohio discussed their anticipated testing process. Later this year Cleveland Clinic wbegin coding claims in both ICD-9 and in ICD-10. Medical Mutual will adjudicate and pay the

ICD-9 claims, while also processing the ICD-10 claims in their test system so the two entitie

can compare results and variances o high-risk claims. The analysis will ocus on complianc

and neutrality in key risk areas to both Medical Mutual and Cleveland clinic.

WellPoint is ocusing its testing on those claims at greatest risk o payment variation

WellPoint, the largest payer in the United States, is also taking a collaborative, risk-based

approach to external testing. Florentino Buendia, Provider Contract Director at WellPoint, nothat WellPoint uses several methods to identify the providers at most risk for payment variat

WellPoint uses the following method:

Identify provider contracts where reimbursement terms are tied directly to

ICD-9 diagnosis or procedure codes

Identify high-risk DRGs, procedures, and diagnosis codes (those most likely to change)

Create simulation models that re-price using ICD-10 language/terms

WellPoint has targeted eight hospital facilities for its rst phase of external testing. WellPoint gi

the providers high-risk ICD-9-based claims (those with high potential or signicant variatio

payment) and asks providers to recode them into ICD-10 claims based on the original med

records. WellPoint manually processes the claims and then jointly reviews the results with provid

Future phases will include a more complete end-to-end processing o claims and an expansto the general provider population.

Taking a risk-based approach to testing based on analysis o historical data is a common elem

to the testing approaches these ICD-10 leaders are taking. This includes identiying high-risk

codes, as well as identiying providers most likely to bill payers using these codes. Successu

external testing will require new levels of collaboration and information sharing among provid

and payers. While it may be uncomfortable to collaborate on such testing, the consequence

big surprises in payments ater the transition date will cause even greater discomort or pay

and providers alike.

Key Takeaway #5:

For Successful Implementation, the Devil is in the DetailsThroughout the two-day event, strategies or success took center stage during bothormal presentations and inormal networking discussions. On Thursday, attendees broke

into moderated, small-group exercises to tackle the issues they voted as most signicant

when they registered.

Readiness is a major concern; traditional change management strategies need

to go external

Whether they were concerned vendor, partner, or organizational readiness, virtually all

attendees expressed concern that their implementation would suer rom a lack o

preparedness. A common thread running through all the various recommendations and

best practices was to adopt a communicate early, communicate oten approach.

From a vendor readiness standpoint, the key recommendation was to conduct a baselinesurvey o all vendors and then use the results to prepare a ull assessment o each, includin

criteria to gauge their readiness. By stratiying the list and creating a dashboard to under-

stand the current state o each vendor, entities could then develop specic communicatio

plans to work with each one.

Both payers and providers cited partner readiness as one o their biggest concerns and

agreed that deliberate, enhanced communication among all internal and external stakehold

had to be a priority. Entities will need to manage multiple work streams (technology, busine

vendor, etc.) and ensure internal groups (such as contracts) are involved. The strongest

recommendation was to evaluate and determine the specic impact and risk o each partne

to ensure the right level o communication and coordination takes place.

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Business/Tech SMEs

Third party

Coder availability

Provider collaboration

Other

What people consideration has been

found to be most challenging?

13.6 %

6.8 %

22.7 %

54.6 %

2.3 %

Application architecture

Data architecture

Vendor implications

Reports and analytics

None o the above

What technology challenges

are you facing?

39.3 %

25 %

12.5 %

21.4 %

1.8 %

Yes No

Have you looked at how you will

prioritize your policy remediation work?

58.7 %

41.3 %

Audience Poll There are no shortcuts to remediating medical policies

Dr. Joe Nichols o Health Data Insights discussed the challenges and best practices around

remediating medical policies. His presentation ocused on the act that while most payers a

probably considering using crosswalks or maps to remediate medical policies, they might e

up with medical policies that are incomplete, or in some cases completely wrong. This will ta

payers urther away rom their goal o nancial neutrality.

The key, Dr. Nichols o Health Data Insights pointed out, was to step back and take a grounds

view o medical policies natively in ICD-10. Medical policies must incorporate the level ospecicity included in ICD-10 while prescribing actions in the delivery o healthcare services

based on medical rationale. Remediation must also incorporate the key objectives o medic

policies, i.e. policies must be clinically driven, demonstrate clear intent, accessible, understan

able, be the single point o truth and be traceable. In addition, medical policies must also

provide a mechanism or clear governance, be collaboratively developed and reviewed, be

accurately implemented and must be tested.

While redening medical policies for ICD-10, it is valuable to review the processes by which

policies are dened, coded and communicated. There are many players clinicians, coders a

systems engineers currently involved in policy denition. However, in most cases, there is

clear way to ensure that the intent o the medical policy was communicated clearly rom on

stakeholder to the next. There are also limited review processes to ensure that the end prod

(medical policy) refects the clinicians original intent.

Code-mapping eforts need to encompass more than the GEMs

By ar, the biggest undertaking or ICD-10 will be mapping the ICD-9 codes in use today to t

ICD-10 codes that replace them. Its a ar-reaching eort that will aect several areas o every

healthcare entitys business.

While the GEMs are a good start to code-mapping eorts, most Summit attendees acknowledg

that they wouldnt solve every need. Most healthcare organizations will use ICD-10 code ma

or a variety o purposes, such as identiying which codes will dene a specic policy, disea

management area, or benet categoryalways important or native updates to back-end

systems. Another use is identiying the specic codes used to analyze data beore and ater

implementation date to ensure accurate conversion o historical data to a consistent code se

Besides the possibility of not having all the codes an entity must consider, the GEMs simplyprovide a list o related codes without providing critical details that explain how and why th

codes are related, or where they dier. For healthcare entities, this means they will have to

spend a signicant amount o time and eort to evaluate those dierences.

During the small-group discussions, attendees recommended that mapping be tailored to

specic policies and edits, rather than relying on a single master map, and then sharing thos

maps with external partners. Moreover, because mapping wont be a one-and-done proce

there was a consensus that it will be important to consider the iterative nature o mapping t

manage rework and the inevitable ripple eects each may cause.

Managing ICD-10 transition across the enterprise requires attention to people,

processes and technology

Summit attendees all agreed that ICD-10 will have a ar-reaching impact o ICD-10 on peoplbusiness strategy, operational processes and technology inrastructure. In one presentation

Deloitte and Blue Cross and Blue Shield o Tennessee (BCBST) discussed the importance o

identiying and engaging an executive sponsor throughout the ICD-10. The discussion also

centered on the signicance o program structure and provided a snapshot o BCBSTs ICD-

team structure, which includes chie compliance, actuary, nance, IT, provider network, chie

medical and application representatives.

Other presentations and small-group discussions around internal readiness noted that existi

best practices around corporate governance could be ideal or ICD-10 projects, particularly t

ensure increased collaboration among business and technology groups. One o the stronge

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Benefcial or could be put to good use

Neutral no impact

Would be costly, but manageable

Potentially catastrophic

Irrecoverable

What would be the impact of a

two-year delay?

3.7 %5.6 %

22.2 %

55.6 %

13 %

Would a delay negatively impact other

healthcare reform efforts?

Yes No

24.1 %

75.9 %

Do you believe a delay will result in

improved readiness?

Yes No

36.4 %

63.6 %

Audience Poll recommendations was to structure the ICD-10 Program Management Oce (PMO) along thsame lines as traditional IT PMO organizations, because o the proven capabilities o such a

structure. However, i an organizations existing IT PMO takes on ICD-10, its KPIs and associat

metrics should be redened to ocus on the objective o ICD-10, rather than the business or

technology group it usually supports.

Both Deloitte and BCBST stressed the importance o bringing all internal stakeholders into

the conversation early on and emphasized that compliance oten has dierent meanings t

people and across departments. One team in the small-group exercise discussed compliancchallenges and recommended that the denition o ICD-10 compliance be dierent rom

HIPAA 5010. Instead o compliant transactions being interpreted between entities, the team

said the rule o law must have a hard cutover date or compliance, meaning parallel submissio

or the same date o service is not an option. The team also noted that paper claims should

treated the same as electronic ones.

And rom a people perspective, Summit participants agreed that the biggest inhibitors to inte

readiness are resource constraints, lack o in-depth training, and deep knowledge o code se

across the organization. This team recommended role-based training delivered right when spe

constituencies need it, a comprehensive knowledge base with easy-to-use look-up tools, impro

processes for collaboration, and potentially outsourcing work that requires specic skill sets.

Key Takeaway #6:Overwhelming Opposition to an ICD-10 Delay

Less than two days beore the ICD-10 Summit convened, the U.S. Department o Health & Hum

Services announced it was considering delaying the ICD-10 implementation deadline or cer

healthcare entities. The potential delay proved to be a hot topic throughout the two-day ev

with many expressing a desire to understand the prevailing mood among their ellow attend

On Friday morning, attendees participated in an anonymous 13-question survey about the

delay and its potential impact on the industry. Based on the results, a signicant majority o

attendees eel that despite good intentions to the contrary, a potential delay o the ICD-10

compliance deadline could have ar-reachingand highly negativeimpact to the healthc

industrys eort to implement the mandate.

The study ound overwhelming opposition to an ICD-10 delay among respondents,all o whom are senior healthcare proessionals actively involved in their organizations ICD-1

transition and carrying signicant responsibility or the overall success o the project.

The majority o survey respondents stated any delay would be problematic and would not

have the eect intended by the Centers or Medicare and Medicaid Services (CMS). Below ar

some o the key ndings:

Overwhelmingly, respondents believe that while a one-year delay would be costly,

but manageable, a two-year delay would be either potentially catastrophic or cause

an unrecoverable ailure

If CMS does delay the compliance date, respondents almost unanimously support clear

communicated and enorced interim milestones to ensure the industry doesnt encoun

the same problem a year rom now

The annual cost of delaying the ICD-10 deadline could exceed $4 billion, based on a 30

percent increase in costs or every year o delay

The survey data indicate a strong preerence among healthcare proessionals or not delayin

ICD-10. Additionally, i a delay is inevitable, most recommend that it not be more than one

year. This desire is likely driven by the concern that a delay will result in budget reezes, work

slowdowns and redeployed resourcesall of which would be extremely dicult to recover

once progress starts up again.

Given the nature of enterprise business and resource planningas well as the multitude of

highly important initiatives that compete or the best talent and most budgetjust the

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n=54

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Edifecs, In10

potential or delay is giving healthcare entities a reason to step back rom their ICD-10 proje

While there may be a few entities that can truly use the additional time to improve their readin

the majority o respondents believe this will not be the case. Instead, costs are likely to spira

higher, and valuable resources may be lost as the industry waits or the outcome o CMS proc

to determine whether the deadline will slide.

The near-term issue is uncertainty. Until the industry knows the ultimate deadline or ICD-10

progress will be stalled. In addition, i the eventual delay is more than a year, the costboth

actual dollars and the eort it will to take regain momentummay be almost unbearably hThe imperative for CMS now is to complete its evaluation as quickly as possible and alleviate

uncertainty around the deadline. I the date does slide, CMS needs to choose a path that wil

keep the industry moving orward toward successul ICD-10 compliance.

A ull report o the survey results is available at

http://www.ediecs.com/downloads/EdiecsSurvey-ICD10Delay.pd.

Conclusion

The ICD-10 Summit generated intense discussions around best practices and lessons learned

organizations already in the throes o their projects. It provided a orum or participants to f

ideas and create rameworks to address particular issues. The key themes refected in this rep

will continue to serve as guidelines or other organizations anduntil a more comprehensiv

study is undertakenwill provide a summary o the industrys current thinking on how bes

approach ICD-10.

With a project the magnitude and complexity of ICD-10, the nal objectives and best practi

or achieving them will be a moving target. Summit attendees recognized this and ormed a

online community to continue the sharing o inormation and ideas.

Even with the uncertainty around the nal deadline date, all attendees expressed a strong

intent to continue with existing plans and schedules. This may be one o the most importan

takeaways o all. In the ace o an unclear deadline, immense internal readiness challenges a

unprecedented levels of external collaboration requirements, healthcare organizations shou

view any potential delay as an added buer against unexpected challenges, rather than an

extension o the deadline.

No one knows exactly what a successul ICD-10 implementation looks like yet. It will likely becombination o proven best practices around governance, project management and organizatio

readiness with new approaches or mapping enormous amounts o data and testing the var

scenarios to ensure a little business impact as possible.

Ediecs is making this report publicly available as a service to the healthcare industry. Excerpts rom

this report (including charts) may be used or editorial purposes without prior permission rom Edi

provided:

Edifecs is acknowledged as the source of the content

Charts are displayed with only minor and necessary edits or changes

A link to the full report is included

(http://www.ediecs.com/downloads/ICD10SummitTakeaways.pd)

The survey results reported in Key Takeaway #6 represent an aggregate o voluntary and anonymoresponses rom more than 50 senior healthcare proessionals. The aggregated data and Ediecsinterpretation o it should not be construed as representing any specifc opinion belonging to otherhealthcare organizations mentioned in this report.

i cd 10 summit takeaways

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