State of the Industry 2011: ICD-10 Preparations

While Medicare says doctors won't be paid unless they are using the updated International Classification of Diseases codes (ICD-10) by October 2013, few providers or commercial payers have fully addressed implementation.

The lack of progress on implementing ICD-10 doesn't surprise J.D. Kleinke, a medical economist and MHE editorial advisor, based in Portland, Ore. The updated codes were a popular issue among healthcare IT leaders as far back as 1992.

"Now we're staring at these new deadlines, but I think the industry has trained itself to know that if it gets down to a game of chicken with CMS, the industry just says the hell with it," Kleinke says. "And what would CMS do about it? It would require CMS to put the hammer down and stop paying. They won't do that. Congress won't let them."

"The world needs ICD-10, but it never gets done," he says. "Without it, we are losing a huge amount of precision in the way we analyze care and the way we pay claims."

The opportunities for advancing with ICD-10 revolve around the ability to perform retrospective analyses. The more precise language and specific codes of ICD-10 would help researchers understand more about the healthcare industry by identifying trends, waste and abuse of the system.

A full upgrade could take a year or more of planning since the code sets are not just one-to-one replacements.

In the meantime, payers and CMS will need to create not just new ICD-10 transactional capabilities but also the ability to process old and new code sets as providers limp along at varying degrees of compliance. The switch won't happen overnight.

"It's just not a big enough crisis compared to all other crises day to day," Kleinke says. "We could spend the rest of our lives waiting for this to happen."

That may be an overstatement. ICD-11 is scheduled to be released worldwide in 2014.