HealthLeaders Media has one of the more interesting reports available.

ICD-10: Skating on Thin Margins has two parts:

1. Results of a survey of hospital executives on how much they expect to spend transitioning to ICD-10 coding.
2. Excerpts from a roundtable discussion of hospital CFOs.

Survey says...

The survey isn't revealing anything too shocking. ICD-10 implementation will be expensive. But what I find really interesting is the responses to the question, "Once your ICD-10 systems become operational, how long do you expect before you realize a return on investment?"

• 27 percent said, "We don’t expect to recoup our outlay"
• 26 percent said, "Not sure "

That's slightly more than half the respondents who aren't counting on getting a return on investment.  That gives you some idea of why doctors are not vigorously appreciating the granularity of ICD-10 coding.

Where's that money going?

Here's the part I'm fixating upon. The round table discussion starts with how much the ICD-10 transition will cost. Some hospitals are budgeting less that $1 million. But several executives argued that is only the IT costs. The total can be 10 times as much once the training costs are assigned.

It's kind of hard to consider training costs as investment. Especially when the training isn't exactly designed to make staff members more productive than they are now. The training will enable them to be more productive in a system that's less productive.

And there are estimates of ICD-10 compliant systems costing the hospital less than $1 million. That's because those systems already are on order as part of a bigger upgrade. ICD-10 code capacity is a perk.

Which seems to fit in with estimates that consider meaningful use and ICD-10 as collaborative projects.

[See also: Week in Review: Trying to figure out the true costs of Meaningful Use & ICD-10 | Meaningful Use: Is it an obstacle or tool for implementing ICD-10?]

The goal would be to save money by purchasing technology that allowed hospitals to satisfy meaningful use requirements and be ICD-10 compliant.

But even if that's possible, this round table discussion puts the emphasis on training and education rather on technology. In other words, the real money seems to be in training not technology.

Which is why hospital executives are not looking to realize ROI from training sessions or count on meaningful use.