First of all, it's not really surprising that they are overwhelming concerned or very concerned about ICD-10 conversion costs, clinical documentation requirements and productivity losses.
Second, the survey respondents are seriously worried about how they're going to actually work with ICD-10 codes. They rated the difficulty of doing the following:
"Ability to document the patient encounter"
- Somewhat more difficult: 48.7 percent
- Much more difficult: 42.4 percent
"Ability of clinician to select appropriate diagnosis code"
- Somewhat more difficult: 31.2 percent
- Much more difficult: 67.3 percent
"Ability of coding staff to select appropriate diagnosis code"
- Somewhat more difficult: 44.5 percent
- Much more difficult: 51 percent
"Ability to include most frequently used diagnosis codes on a superbill"
- Somewhat more difficult: 26.7 percent
- Much more difficult: 60.3 percent
"Ability to compare new diagnosis data in ICD-10 with previously collected diagnosis data using ICD-9"
- Somewhat more difficult: 45.3 percent
- Much more difficult: 44 percent
That block of responses tells me three things:
- Physicians are convinced that ICD-10 is completely impossible to understand and use. I'm surprised "onerous bureaucratic requirements" wasn't used in this section.
- They're probably right about the fate of their superbill. And there's more that needs to be discussed later about this.
- The fact that the MGMA asked about how concerned physician practices are that they will not be able to compare ICD-9 data with ICD-10 data shows they have a sense of humor. Now they're worried about diagnosis data?
But I'm really interested in how much practices are going to pay — or not pay — to upgrade their systems. About 41 percent are using practice management systems (PMS) that have free ICD-10 upgrades. A fraction more will have to pay an average of $11,500 per physician to upgrade their PMS.
Electronic health records (EHR) customers are in better shape. Almost 51 percent say their EHR upgrades are covered. About 36 percent will need to pay an average of $12,885 per physician to upgrade their EHRs.
There could be a variety of reasons why some upgrades are covered. But if you're represented by the medical practices who responded "I don't know," it's worth the while to find out.
This post is a pretty good primer on how to participate in ICD-10 testing with MACs in March. There are a couple good points to emphasize:
- Healthcare providers need to have Medicare claims coded in ICD-10 to participate.
- MACs are only going to accept or reject the medical claims. They will not offer any feedback.
This is really good news for Massachusetts healthcare providers. (Mass Health Data Consortium)
- ICD-10 training needs to be tailored to physicians and their specialties.
- Physicians need flexibility. You won't be able to schedule all of them for a classroom session.
- Peer to peer is great but clinicians and medical coders need to learn together.
- The Centers for Medicare and Medicaid Services wants healthcare providers to take clinical documentation seriously or risk being fined.
- "Good documentation actually benefits not only the data collectors, but your ability to interact with patients."
- Find ICD-9 coding deficiencies and address them as part of ICD-10 coding.
- Consider online training.
- Focus on your medical specialty.