Abstract
In 2014, the US is set revolutionize its healthcare industry. On the 1st of August, the country is expected to make major changes in its healthcare information management system. The change will be marked by the introduction of International Classification of Diseases, Tenth Revision (ICD-10).
The new system will replace the existing ninth revision. All healthcare service providers are expected to have implemented the framework, failure to which they will be denied license to practice. No further grace periods and extensions will be provided.
As a result, the focus of stakeholders in this industry has shifted to healthcare information management specialists. The specialists are charged with the responsibility of spearheading the implementation of the new system.
The ICD-9 code is used in the country’s healthcare system for a number of purposes. For example, it is used to report inpatient procedures and medical diagnoses. The framework provides support for electronic transaction. However, ICD-9 is set to be replaced by ICD-10.
The latter is an improved version of the former. The new system will be introduced on the 1st of October, 2014. It is set to bring about significant changes to the management of healthcare information.
Specialists working in the Healthcare Information Management (HIM) sector anticipate the changes to ‘revolutionalize’ the health industry. There are other developments that are anticipated in the industry as a result of the new system.
They include the introduction of the Health Insurance Portability and Accountability Act [HIPAA] (Sean, 2012).
With the implementation of ICD-10, the HIPAA standard will be upgraded from the traditionally used 4010/4010A version to a more advanced 5010 edition (Centers for Medicare & Medicaid Services [CMS], 2013a).
The new changes are likely to improve the provision of healthcare services, especially with regards to revenue collection and payment procedures.
In this paper, the author is going to look at some of the issues revolving around ICD-9 and the new version, ICD-10. The aim of this paper is to review the future and place of this new system in the American healthcare system.
It is a fact that implementation of the new mechanism is bound to face a number of challenges. Some of them include lack of capacity among healthcare organizations, as well as possible resistance from various stakeholders.
The impacts of such hurdles on the efficiency of the new system will also be reviewed. A total of 35 journal articles were accessed from Google Scholar, Medicaid, and Mediplus databases.
An exclusion and inclusion criterion brought down the number of these journal articles to 13. A thematic analysis methodology was used to review the content of these articles in relation to the topic.
Literature Review
Major issues associated with the adoption of ICD-10 are brought about by the dynamics of the healthcare industry (Dimick, 2010a). Dimick (2010a) arrived at this conclusion owing to the fact that only slightly over half of the organizations operating in the industry have commenced transition to ICD-10 by April 2010.
Dimick used the findings of a survey carried out by the American Health Information Management Association (AHIMA) on April and August 2010.
In this survey, 53 percent of the respondents stated that the organizations they worked in had already laid down plans to implement ICD-10. On their part, 46 percent of the participants had no idea when the process would begin.
Coding experts have expressed concerns that delaying the implementation process will make it hard to beat the set deadline. According to the August survey, inpatient hospitals have been on the forefront in the adoption of ICD-10.
In the study, 62 percent of the respondents stated that their hospitals had already started to implement the system. The study conducted in April revealed significant support for the new system. For example, 56% of the inpatient hospitals had already started using ICD-10.
However, 38 percent of the hospitals had not implemented the system. Out of these, 18 percent stated that they commence in the coming six months, while 41 percent had no idea when the implementation would start (Dimick, 2010a).
The findings made in the August survey showed that progress had been made within a span of four months. Some of the major milestones that had been achieved included upgrading to HIPAA 5010. The system is the new version of the transaction standard to be used with ICD-10.
Additional milestones involved the determination of the organizational structure. Other organizations had already started setting up steering committees to spearhead the transition process. By August 2010, 22 percent of the respondents stated that their organizations were halfway towards full implementation of ICD-10.
However, only 14 percent had indicated the same progress in April (Dimick, 2010b). Failure to meet the 1st August deadline could result in dire consequences, such as denial of services in the healthcare industry. The Centers for Medicare and Medicaid Services (CMS) has stated that no further extensions will be provided.
Implementation of ICD-10 is a complex process that requires the joint efforts of all stakeholders in the healthcare industry. The HIM specialists play a significant role in the implementation of ICD-10. Upgrading the current systems forms the basis of implementing the new coding regime.
The greatest task lies in the software and hardware upgrades. Some components need to be modified or changed to accommodate the new system.
They include office settings, servers, and computers. Additional hardware, such as cables, may also be required. The organizations are expected to consult the vendors with regards to the additional technology needed (Sullivan, 2010).
The implementation of the new coding system will require the joint effort of all healthcare professionals (Averill & Bowman, 2012). The professionals involved in coding, as well as those who perform diagnostic functions, play a significant role in the success of ICD-10.
It is important to note that new codes are made from the existing medical records. As such, the individuals carrying out diagnostic procedures must record their findings in a manner that can be easily interpreted by the HIM specialists.
Such recording will make it easier for the information to be translated into codes. In addition, those carrying out diagnostics must be in a position to interpret the codes generated (Cartwright, 2013).
In most cases, ICD-10 is rolled out over several years. For this reason, the process is characterized by multiple projects that vary depending on the time the implementation is scheduled to occur.
Mini budgets are prepared to cater for each year’s expenses and contingencies. Training coding professionals on ICD-10- CM/PCS should be carried out at least six months before implementation. HIM departments need to set aside resources for education opportunities (Heubusch, 2010).
HIM professionals should receive training on a number of areas, which include project management, application development, and operations reengineering (Bowen, 2010).
AHIMA recommended the last ICD-9-CM update to be made at the beginning of October 2012, which is the end of the Fiscal Year (FY). No updates should be made to ICD-10-CM/PCS for 2013 and 2014 FYs. Planned revisions should only begin in 2015 FY, which commences on the 1st of August, 2014.
Methodology
Databases and Search Terms
Information used to complete the research was obtained from a number of databases. They included Medicaid, Medicare, and Google Scholar. The three were selected as a result of the variety of journals published in them. The first two (Medicaid and Medicare) contain articles that are relevant to the healthcare sector.
The last one (Google Scholar) is characterized by articles covering a wide range of topics. The journals found in these sources are mostly academic and professional. For studies to be published in the journals found in these archives, they have to undergo scrutiny from professionals in the field.
Such scrutiny is meant to ensure that the findings reflected in these articles have been arrived at following a systematic research.
The online libraries are also reviewed on a regular basis to ensure that they contain up-to-date information. As a result, the information found in these sources is relevant to emerging issues in the healthcare industry.
The three databases identified above were considered to be the most appropriate in providing information concerning the implementation of ICD-10. To obtain the articles related to the topic, a number search terms were used. The search words included ICD-9 and ICD-10.
However, the terms generated articles that contained generalized information. As such, more specific key words had to be used. The researcher keyed in the following keywords:
- ICD-9 + failures,
- ICD-10 + success,
- ICD-10 + implementation,
- ICD-10 + efficiency.
Inclusion and Exclusion Criteria
At the end of the search process, the researcher came up with a total of 35 journal articles. To complete the research, only 13 sources were needed. The researcher had to adopt an exclusion and inclusion criterion to come up with the final list of sources. The inclusion criteria involved a careful assessment of the articles.
To begin with, the sources selected had to be published in reputable journals. Since the data needed for the research was professional in nature, peer-reviewed journals were selected. In addition, the articles had to be relevant to the topic of the study.
Sources that contained the key terms ICD-10 and ICD-9 were preferred over those that did not. The affiliation of the authors also determined whether an article would be used in the research or not.
The sources authored by scholars associated with agencies and organizations that actively participated in the implementation of ICD-10 were selected. Such organizations included, among others, Centers for Medicare and Medicaid Services.
Articles to be used in the research also had to be recent to provide up-to-date information. Since the study revolved around the American healthcare system, articles to be used had to provide information specific to the country.
The exclusion criteria used in the research was aimed at cutting down the number of articles used from the initial 35 to 13. To begin with, sources providing information about another country other than the USA were excluded. Only data relevant to the American healthcare system was required.
Articles that were more than 5 years old were also excluded from the research. The sources were not used regardless of their relevancy to the topic. As already indicated, up-to-date information was needed to reflect the developments in the field.
As such, recent sources were selected to provide the researcher with information on the progress made in the implementation of ICD-10. Articles from unprofessional sources were also excluded from the research. The researcher was only interested in professional data sources. That is why peer reviewed articles were used.
Data Analysis
The matrix method was used to analyze the data obtained from the sources. Using the matrix analysis, the researcher took into consideration specific themes that needed to be addressed. The researcher was particularly interested with the nature of ICD-9, ICD-10’s predecessor.
The author introduced ICD-9 to inform the audience of the changes they should expect with the new system in the healthcare industry. The researcher also focused on ICD-10 as the ‘much awaited’ system.
Reasons why the new approach should be anticipated were also analyzed. In addition, the researcher focused on the implementation process, the challenges to be anticipated, as well as the agencies and persons required to spearhead the process of putting in place ICD-10.
Results
ICD-10: An Ambitious Program by the Government
From the articles analyzed, it was found that the implementation of ICD-10-CM/PCS will be one of the most expensive activities that the US healthcare industry has undertaken in the recent past (Heubusch, 2010).
For example, a study carried out in 2003 by Robert E. Nolan, a consultancy firm that had been contracted by the Blue Shield and Blue Cross Association, revealed the costs that will be incurred in rolling out the new system.
It was found that it would cost the country between $5.5 and $13.5 billion to implement ICD-10. A further productivity loss of between $752 million and $1.4 billion is also expected.
However, the cost is expected to be higher since the study did not consider the impacts the system will have on nursing homes, suppliers of durable clinical-equipment, clinical laboratories, claims clearinghouses, and third-party administrators in the industry.
The scope of the study was limited to healthcare organizations in general. The individuals carrying it out ignored the fact that the impacts of the new system will go beyond the conventional healthcare firm.
Another study carried out in 2004 by the Rand Corporation for the National Committee on Vital and Health Statistics provided similar estimates.
The study revealed that the cost of adopting ICD-10 will range from $475 million to $1.53 billion. The study also estimated that the benefits associated with the implementation will range between $700 million and $7.7 billion (Bowen, 2010).
ICD-10: The Future of the American Healthcare System
The shift from ICD-9 to ICD-10 will help improve the efficiency of the healthcare system. The improvement will be achieved through the introduction of enhanced data collection tools (Heubusch, 2010).
The enhancements in healthcare services following the introduction of the new system are expected to be realized through the provision of specific information.
Such information will narrow the scope of the healthcare issue under study. The system will also provide medical practitioners with improved diagnosis information to help them deal with diseases affecting the population.
However, for the system to be effective, healthcare centers and organizations must familiarize themselves with the new set of codes. To achieve this, individuals working in these institutions must be adequately trained (Heubusch, 2010).
Education on clinical documentation also needs to be provided to prepare the health practitioners for future challenges likely to be encountered in the coding process.
Through such training programs, the persons responsible for coding will be equipped with the knowledge required to translate the information contained in the medical records. The organizations are expected to develop tools to assess the impacts of the new system.
The tools will help the health institutions to determine the efficiency of the new arrangement. In addition, such mechanisms will be used to determine the ease of recording new information and the efficiency of the system with regards to retrieval of data.
It is noted that healthcare institutions deal with a large volume of data, some of which is confidential. It is important to enhance the safety of such information when archiving it. The aim is to ensure that the information can be retrieved easily, but only by authorized personnel.
The tools develop in line with the new system will a critical role in achieving this objective. They will help the personnel to analyze the security measures undertaken to protect information from unauthorized personnel, as well as its compatibility with the previously used framework (Buckholtz, 2010).
To this end, it is important to ensure that the data is not lost in the process of transiting from the old framework to the new system. The healthcare organizations are also expected to put in place mechanisms to help in prioritizing and mapping out health issues, as well as in training (Sean, 2012).
ICD-10 and Clinical Modification/Procedure Coding System (ICD-10-CM/PCS)
The changes expected in the United States of America’s HIM are necessitated by the need to improve the country’s capability in handling of medical records (Department of Health and Human Services Centers for Medicare & Medicaid Services, 2013).
The new framework that is set to be introduced in 2014 (ICD-10 and Clinical Modification/Procedure Coding System [ICD-10-CM/PCS]), has two major elements. The nature of the two facets sets this arrangement apart from the previously applied system.
The first is the ICD-10 and Clinical Modification (ICD-10-CM). The element is used for diagnosis coding. It is applied in all settings in the United States of America’s healthcare system. Its code comprises of 3 to 7 digits, compared to the traditional ICD-9-CM that uses 3-5 digit codes (Heubusch, 2010).
However, the format of the codes is similar. The second facet is ICD-10 and Procedure Coding System (ICD-10-PCS). It is concerned with the procedures used in inpatient coding. It is only applicable within a hospital setting. ICD-10-PCS uses a 7 alphanumerical digit code.
The coding is central to that of ICD-9-PCS, which uses 3 or 4 digits. As a result, the new system will help to code for a wide range of inpatient issues in the USA compared to its predecessor. The improved capability is one of the strengths associated with this system.
The need for ICD-10 is made apparent from the fact that ICD-9 provides limited information concerning the inpatient procedures carried out in a hospital. The 9th version also provides inadequate data with regards to the health condition of patients. ICD-9 is 30 years old.
It is regarded by many people as an outdated system. It is also inconsistent with the current healthcare procedures in the country. Most of the classifications used in the current system are fully utilized. As a result, it is difficult to code for emerging health issues.
Preparations to switch to the new system began a number of years ago. However, adapting to the new coding environment is likely to pose a challenge to the HIM specialists. It is important to note that many countries have already switched to ICD-10.
However, the US continues to use the old system with regards to morbidity and mortality. The country is different from other developed nations. It is the only one that continues to use ICD-9. Today, over 100 nations are using the new system to complete a number of processes.
For example, it is used to report death cases. Nordic countries were the earliest adopters of ICD-10. They started a 4 year implementation program in 1994. United Kingdom adopted the system in 1995.
ICD-10 has 22 chapters (Heubusch, 2010). Today, service providers in USA use ICD-10 to record mortality data only. They continue to use ICD-9 to record morbidity, Medicaid, and Medicare claims.
Both ICD-10-CM and ICD-10-PCS have not been used before in the USA. Their use will commence on October 1st, 2014, when ICD-10 is expected to be launched.
Implementation of ICD-10 and the Challenges Involved
It is the responsibility of the Department of Health and Health Services (HHS) to oversee the implementation of ICD-10. The implementation deadline has been extended a number of times in the past. For example, the system was to be implemented in 2011.
However, the deadline could not be met due to a number of problems associated with the system. One of the problems associated with its implementation is the fact that its codes are approximately 10 times more than those used in ICD-9 (Heubusch, 2010).
ICD-10 has a huge number of codes. According to Heubusch (2010), the ciphers are approximately 140,000 in total. The American Association of Professional Coders (AAPC) has highlighted this issue. According to this organization, one code can be used to represent a condition and its associated symptoms.
The adoption of ICD-10 also requires transition to HIPAA version 5010. In addition, medical claims made in the past will be converted to ICD-10. Failure to convert these claims will lead to their rejection. As a result, the transition process is expected to affect the diagnosis of persons who were previously covered under HIPAA.
As the deadline approaches, the realization of ICD-10 is likely to be the most important objective in healthcare facilities across the country. Focus is now shifting to HIM specialists who are expected to showcase their level of expertise in guiding the process (Heubusch, 2010).
The ability of the USA healthcare system to effectively implement ICD-10 within the stipulated deadline relies on these professionals. The new system requires a precise electronic medical documentation framework.
For this reason, healthcare organizations need to analyze the transition gaps that exist within their current ICD-9 system to understand what needs to be done to implement ICD-10.
It is important for HIM specialists to work closely with the system vendors to ensure that the available data is not lost during the transition. The vendors should ascertain that their products are ready to avoid delaying the implementation process further. The dealers are also required to use applications of recognizable standards.
They are expected to assist health practitioners when the need arises. The new system should also be tested to understand the issues associated with it prior to the launch. The practice will help the HIM specialists to deal with major problems before the implementation.
Testing prior to the launch of the new system will also ensure that the implementation process will not be further delayed as the new issues are being attended to. It is also important to identify the additional vendor-related costs that may be incurred following the adoption of the new system.
The aim of this is to ensure that the organizations are adequately prepared for any new issues that may arise (CMS, 2013b). HIM specialists are required to identify any adoption and conversion procedures that may simplify the implementation process.
Simplifying the adoption process would help cut on the cost of implementation. Fewer resources would also be required. All employees expected to participate in the process should be adequately trained (Dowling & Wisdom, 2010).
Conclusion
The implementation of ICD-10 is a tough task. It cannot be achieved within a short duration of time. Years of planning are required for the system to be effective. For this reason, the proposed shift from ICD-9 to ICD-10 is anticipated to be a major challenge in information technology (Bowen, 2010).
With a deadline already in place, players in the industry have no option but to make the changes within the stipulated timeline.
Medical facilities that are yet to implement ICD-10 should realize that they have very little time to complete the process (Heubusch, 2010). HIM specialists are required to be conscious when implementing the changes. Mistakes may lead to a crisis in the healthcare industry.
References
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