Rady Children's Hospital in San Diego is further along in its ICD-10 planning than a lot of other organizations. Even so, says CIO Albert Oriol, they're not yet in view of the finish line. Among the remaining challenges: training coders and physicians on the new system, assembling the right team, and ensuring they have the technology and tools they need to complete the project.
Rady, a 442-bed facility that is California's largest pediatric hospital, got started early on ICD-10, in part, because leaders there realized it was "bigger than a coding project," Oriol said during a recent ICD-10 panel at the College of Healthcare Informatics Executives (CHIME) fall forum. It's so easy to lose focus in the face of other pressing technology projects, such as implementing electronic health records and preparing for meaningful use. It's also easy to put your head in the sand and hope that the government will delay ICD-10. "I just don't see it happening," he said.
Although he's "fairly comfortable taking risks," Oriol wasn't willing to gamble on an ICD-10 reprieve. Consider, he said, that poor ICD-10 preparation could increase your current denial rate by 1% - 3%. He asked the audience: Is that a risk you're willing to take?
There's a lot of apprehension among Rady's coders—and one has already resigned, well ahead of the October 2013 conversion deadline, said Cassi Birnbaum, Rady's director of health information and privacy officer. Conventional wisdom holds that many coders will change jobs or retire before the conversion, which will increase the number of disease and diagnosis codes from the current 15,000 to more than 150,000. Further, the new coding system is much more complicated and nuanced than ICD-9.
But it's not just coding professionals who should be worried. ICD-10 experts say organizations that aren't prepared could face significant increases in accounts receivable, rapid decreases in cash flow, high call volumes because of rejected claims, and risk of increased audits and sanctions.